Basics of Socket Grafting Part I

A four walled bony defect has excellent healing potential when grafted.  However, if left on it’s own has an equally good chance of resulting in a atrophied site which may require more complex and costly grafting.  Today the best means of ridge preservation is by immediate implant placement.  The second best is socket grafting. The most common question I am asked by my restorative colleagues is what I use for socket grafting and what is my technique.  I think it is a great question if someone is preforming extractions in their general practice.  When I started practice 10 years ago I had to take a leap of faith into socket grafting as it was an emerging procedure and technique.  Today we have volumes of literature supporting it’s success.

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I personally believe it should be considered negligent not to offer this benefit to a patient in 2010 as part of an informed consent.  Bone is a very difficult tissue to regenerate.  It’s preservation after tooth loss is beneficial not only as a foundation for future implant placement but also to preserve the youth of the facial form.  The sunken appearance of denture wearers is partially attributed to bone loss from extractions.  Below I give a summary of my technique with no academic support or detailed rationale for the technique.  I hope to do so in future entries.   My own preference is a 50:50 mix of cerasorb and puros packed moderately covered with a regentex membrane and silk sutures.  In one week I remove the sutures; in two weeks I peel off he membrane.  There is a three month healing time prior to flapless implant placement.  Local infiltration is critical for hemostasis or else your graft will float away.  The membrane is neatly tucked under the gingival margins or it will fall off within a few days.

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