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Upper first premolar removed 4 weeks ago due to an abscess. Buccal bone fenestration noted during socket curetting CBCT taken two weeks after the exo appt to confirm the bone defect. (as below) Socket preservation was treatment planned to carry out in a few days which will be 4 wks after the initial exo appt. My question is, if the tx plan is NOT to be changed, would you clean out the stuff in the socket completely and fill it with Bio-oss? or would you mix the bio-oss with the newborn tissue in the socket?
8 Comments on Socket graft 4 wks after exo: bio-oss in socket?
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I would have grafted at the same time. At this point I would re-curette socket then graft.
I would not use xenograft, because of the delayed turnover. I would use cortico-cancellous allograft.
I agree with the other posts - BioOss xenograft is not indicated for socket preservation when you plan to place an implant within a few months. Use Allograft -Cancellous or a corticocancellous mix will work. Also, clean socket walls and stmulate some new bleeding.
I've used allograft for 30 years. In the last two years I've been using Biphasic Calcium Sulfate (Bond Apitite from Augma or Socket Graft Plus from SteinerBio). As opposed to Allograph, there is little of the graft left after a few months. It is simple to apply and each company has videos that can show you how easy they are to use. Calcium Sulfate also has the advantage of being Bacteriostatic.
If you don't a lot of experience placing implants, I will play it safe waiting about 8-10 weeks based on literatures then go back. You will have good soft tissue to get primary or close to primary closure of the site. Use Allograft (Cancellous or Cortico-Cancellous mix) as other suggested but also try to close the fenestration with membrane. You could use Ice Cream Cone Technique from Dennis Tarnow. Good luck
I would do nothing. The ridge is very wide with an intact buccal plate and radiographic evidence of immature bone. Just wait 4 more weeks and place the fixture
Mother Nature is more than capable of finishing the job and filling this socket with native bone if we just stay out of her way... Any material introduced into this site at this point IMHO would be done purely for monetary gain and has no biological justification!!!
Clean out the socket of any soft tissue, graft with allograft, cover with either resorbable membrane or non-resorbable membrane. Wait 4 months, check result with CBCT and proceed from there.