Socket grafting after extraction of an infected endodontic tooth?

How do you treat and clean the socket after extraction of an infected endodontic tooth and prepare it for the bone graft for ridge preservation? I have heard not to use chlorhexidine after curetting the socket. So is just the sterile saline or water sufficient along with PO antibiotics? Is it a good idea to mix some clindamycin in the bone graft and then pack it?

10 thoughts on: Socket grafting after extraction of an infected endodontic tooth?

  1. Timothy C Carter says:

    Just place the graft. All of the CHX, Antibiotic etc.. is just preference with no clinical evidence to support any of them. Same goes with the graft material you choose. If it works in your hands than drive on.

  2. Dr. Gerald Rudick says:

    Do not be in a hurry to graft into an infected socket……. remove the tooth, curette the socket, not a bad idea to rinse with Peridex and irrigate with sterile saline, get the remnants out….do not graft at this time… then leave it alone for 3-4 weeks so the bad cells will be sloughed off and the soft tissue will close.
    When you go in a second time, you are going into a non infected healthy site and your graft will be well received…. there will be new blood vessels developing to supply your graft, osteoblasts and growth factors will be present as the healing process has started……….the soft tissue has closed, so you will be able to have complete closure of the site, and the gingival tissue will be sufficiently mature to manipulate and stretch should you want to bulk out the site to get vertical and horizontal growth.

    • Tom D says:

      When you delay the graft for 4-6 weeks, then go back, flap the area, what has grown into the socket(s) ? What exactly are you removing from the sockets, or how much, such that bone can be placed…
      and if i am going to be placing a graft to build up the buccal, like with a titanium reinforced kevlar (non-resorbable) membrane where I am going to score the tissues and pull it over the now bulging graft–is 4-6 weeks post extraction of infected tooth area long enough to allow me to get a promising primary closure

  3. Vipul Shukla says:

    Extract gently, preserve as much bone as possible, then curette the socket till you reach hard bone, that includes the apical area, and then you can place an immediate, or delayed immediate (5-6 weeks)or standard after 120 days, all should give predictable results. Remember, if buccal bone plate is resorbed, avoid immediate implant placement. yes, I avoid flushing socket with CHX, as some studies say it is toxic to immature osteoblasts (theory makes sense), a good, thick blood clot or clot mixed with graft will give you a good foundation for future success.
    Good Luck!

    • Cliff Leachman says:

      Clean out all the tissue, wipe with plasma , suture in multiple plugs of A-PRF+, check the next day.
      Did that yesterday with fractured lateral with large periapucal radiolucency, today no swelling an d very little pain. Works amazingly well, cheap as well, as the naturopaths like to say, “ like cures like”!

  4. CRS says:

    Understanding biology of infections is key. I have seen complications with the localized osteomyelitis after removal of a chronically infected root canal treated tooth. No X-ray to determine degree of infection, root fracture or history. Cookbook technical approaches listed here. Periimplantitis usually shows up between 4-6 months after implant placement exposes the dormant bacteria. Need to treat the offending infective agent appropriately it’s got a head start on you. Need to know how to appropriately treat sequela and failures. It’s expensive. Posts don’t seem to understand biology of bone healing.

    • Tom D says:

      I would claim that the majority of teeth i remove to eventually implant are chronically infected RCT teeth
      I would not want any dormant bacteria to spoil my case…thanks for the heads up!
      so then, with a chronically infected RCT tooth that is just removed, and not immediately implanted…how long should i wait until i go back and, say, graft the area?
      Are you a fan of using antibiotics?
      And what else do you suggest to destroy the dormant bacteria?

  5. steve hinze says:

    Why put a graft or implant in an infected site? You want trouble? That’s what you’ll get. Respect infections. Clean them up first. You still won’t get 100% success. If you do, you haven’t done much.

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