Socket Preservation Techniques: What is working?

Alot depends on if all the bony walls are intact or if there is a buccal dehiscence or fenestration or if most of the buccal wall is missing; in addition, if there has been loss of vertical height.

We regularly use Easygraft, and depending on the number of remaining walls (or missing ones) we use either classic or crystal. But mostly we use Crystal for its qualities and simplycity to use... no membranes means no hustles.

Foundation for affordable 80% volume upon healing or bioss and collagen plug for better healing volume but at more cost. If under bridge or partial than synthetic bioplant.

I have been using a relatively new product from Impladent Ltd called the Osteogen Plug which can be purchased from the DDSgadget website and it has been nothing short of great. I had wondered for years why someone hadn't made a collage plug type graft which could be placed like a collagen plug but act like a graft, going so far as to try and make my own "stuffy" with graft material placed inside a mostly hollowed out collagen plug. Finally Impladent did it. I have successfully grafted intact extraction sockets as well as three wall defects with this product. In addition to the ease of use of the product, there is a built in indicator in the material which gives you a good idea of when the area is ready to be implanted. While the material is initially radiolucent upon placement, three to four months later the area will appear opaque on a radiograph. I usually give the area a total of 5 tom6 months for full maturation. For $50 per plug it's a no brainer in my opinion.

This is an interesting topic. As someone involved in the marketing of materials and the supporting communication around them I often feel the phrases we accept can be misleading. As DrT suggests a defective socket may requires hard tissue healing (repair or regeneration). This is not the same as an intact socket where the objective is in some way to reduce or arrest natural resorption associated with tooth loss (ridge preservation). Likewise, a ridge preservation technique in an intact socket ahead of a planned implant placement may require different materials to that associated with a bridge. Doctors should be aware of the differences in materials and look for this level of understanding in the companies and products they choose.

First I would recommend that people stop using the term socket preservation. You are not doing these techniques to preserve the socket but you do want to preserve the ridge. RIdge preservation is a much better term. If I have all 4 walls present I place Rocky Mountain irradiated mineralized bone into a well curetted socket and then place a Cytoplast PTFE membrane over the socket sutured with PTFE sutures. I allow this to heal for 4 weeks and then remove the sutures and membrane. In most cases there is a very nice layer of granulation tissue over the grafted bone. I then allow this to heal for a total of 4 months before placing an implant. My technique is going to change because of new research from Dr. Nelson Pinto from Chile. He is showing that you can just place PRF into the socket, suture over the site to contain the PRF and allow the site to heal for 3-4 month before implant placement. The total cost is about $10.00. You can follow more discussion on another osseonews post for more information. http://www.osseonews.com/using-prf-scaffold-bone-regeneration-thoughts/

You definitely do not need a membrane when there are 4 walls...why incur the extra expense? Use whatever allograft you want and just cover with a couple of layers of collagen plug and a criss cross suture. I am not sure you need to harvest PRF for this procedure either.

Agree with Dr.I.love pdf but in a four wall defect really allograft and collate.

I am with Alejandro and Robert Teague here synthetic materials are highly osteo -inductive , as seen for years in orthopedics and spinal surgery and now finally the Bern university ( Sculean and Buser , Coir 2015 ) ....... so we can up-regulate host healing response . Yes PRF is great in sinuses but is limited elsewhere unless mixed with other materials ...... so called "sticky Bone " , which again is an abuse of the English language .. Regards Peter