Socket Grafting: Standard of Care?

Last Updated: Sep 19, 2016

I saw an article on Dental Economics concerning whether Socket Grafting should be a standard of care or not. In the article, Dr. Gordon J. Christensen, states:

“Socket grafting is not yet œstandard of care, but in my opinion it certainly should be, at least in the smile zone…I suggest that all dentists should accomplish this simple technique of socket grafting. The technique is especially important in areas of the mouth where bone and soft tissue shrinkage will not allow adequate implant placement, or would necessitate placing an unsightly pontic if an implant is not placed. Using products and concepts that potentially decrease the cost of socket grafting are discussed and identified for you.”¹

I am interested in what others think about socket grafting. Is it something you have incorporated into your practice after each extraction? How do you best convince the patient of the necessity of this procedure? Has cost been an issue?

1.[Is Socket Grafting Standard of Care](http://www.dentaleconomics.com/articles/print/volume-102/issue-7/practice/is-socket-grafting-standard-of-care.html)

7 Comments on Socket Grafting: Standard of Care?

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Sam

09/19/2016

Interesting article. I would just like comment briefly on the cost issue, brought up by Dr. Gordon J. Christensen. I don't think the material costs are entirely accurate, because you can save money, by considering alternatives, and buying online. Here are a few ideas: Benacel Dental Dressing, made of biocompatible oxidized cellulose , starts at only $36 for a pack of 8! There is also a new product on the market called Osteogen Plug, which costs around $50 per plug, and combines a standard collagen plug with a synthetic graft, and may not require a membrane in many cases. If a standard collagen plug, is your go to choice, then you can save with bioPlug. As far as membranes are concerned, Cytoflex Resorb, a popular synthetic membrane, starts at only $50. Neomem, the standard collagen membrane can be bought for under $90 when you buy in bulk.

DrT

09/20/2016

It is pretty difficult to say there is a Standard of Care of socket grafting when there is hardly a standard protocol.

Brian

09/21/2016

Used to think I knew what "standard of care" meant. It should definitely be offered for almost every extraction. Even if no implant is planned. Doesn't really answer the question I know but my answer is no, it isn't standard of care but should be explained to a patient and allow them to accept or deny

Dr.CDT

09/21/2016

what we know in the literature with resorption rates of up to 50% 6 months post extraction, every socket should be grafted with a long term stable bone substitute.

Dennis Flanagan DDS MSc

09/22/2016

We need to be careful here. Research on this is conflicting. When there is no facial plate grafting with a barrier is needed to minimize bone loss. When the facial plate is present and thick grfating is probably not necessary. One useful technique is post extraction have the patient close on a sponge for 40 minutes by the clock two time to insure a clot formation with subsequent bone fill. There may be commercial interests advocating formation of a standard of care. Grafting is expensive and may make an extraction/grafting unaffordable for some. Additionally, there may be grounds for a lawsuit if grafting is not done, even if the patient declines it. Dennis Flanagan DDS MSc

James

09/23/2016

Pretty difficult to say there is a Standard of Care of socket grafting.

greg steiner

10/01/2016

In a recent study out of a Belgum University they studied bone resorption after extraction. The study was limited to bicuspids and anterior teeth. Immediately after a tooth was removed a ct scan was taken. Three months latter another ct scan was taken and overlaid over the original ct scan. They found an average of 5 mm loss of width at the crest when no grafting was done. Other studies have found when bone grafts had been placed the resorption was limited to 1 mm. Maintenance of the ridge is only one reason to graft a socket but these findings are enough to make it an obligation to advise socket grafting and let the patient decide. In my practice if a patient does not want a socket graft I refer them to someone else because I don't want to deal with the negative sequela of mediocre therapy. Greg Steiner

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