I have a 55y/o male with controlled diabetes presents with the following findings as seen in Figures 1 and 2. The patient denied any symptoms on #15 [maxilary left second molar; 27]. The patient agreed for me to extract #15 and eventually replace it with an implant in the future. In 4/2013 I extracted the tooth and attempted to do a bone graft with membrane. Upon extracting the tooth I noted that the distal buccal root was fractured resulting in excessive amounts of periapical granulation tissue. I attempted to place the graft by aggressively curreting to remove as much tissue as possible so that the graft would have a bony contact. One week after the extraction the patient calls and reported swallowing the membrane. I took a radiograph (Figure 2) and you can see that some of the graft is still present in the extraction site and it just appears to be “floating” with no bony development. Can you do site preservation in cases like these where there is excessive granulation tissue due to root fractures, periodontal disease, or teeth with periapical infections? Or should I wait till after the area has healed? Is there any way to improve bone density in the extracted #15 site for future implant placement? Now I have a similar situation for tooth #4 [maxillary right second premolar; 14] (Figure 3). What should I do in this case to improve the prognosis for an implant in the future?
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