Page 18 - GP Fall 2019

Case Report: Extraction and Socket Graft
Using Synthetic Bone Material

by Spyridon Condos, DDS

Introduction Procedure
Socket grafting has been shown to be The patient presented at recall with a A mixture of synthetic bone (Biogran, 3I –
an excellent method to preserve bone bleeding 7mm pocket on the mesial of tooth Palm Beach, FL) and pharmaceutical grade
in an extraction socket prior to implant #4, which had been restored over twenty calcium sulfate was prepared and placed
placement. It has been shown to reduce years ago (Figures1,2). X-ray revealed into the socket after degranulation. This
1,2
both horizontal and vertical bone loss by mesial bone loss with a probable root was covered with two separate layers of
1-3mm. fracture, as the post had fallen out more Bio-Mend Extend (Zimmer Biomet, Palm
2
than once and had been replaced (Figure 3). Beach Gardens, FL.). The graft/membrane
In this case, a maxillary second premolar, was stabilized with 4-0 chromic gut
tooth #4, was extracted and immediately suture and covered with a tissue adhesive
grafted with a mixture of a synthetic
bioglass bone graft (Biogran) and generic
pharmaceutical grade Calcium Sulfate. No
flap was elevated, and the socket opening
was covered with two separate layers of
a dense collagen membrane (Bio-Mend
Extend). This was sutured into place with
4-0 chromic gut sutures, and sealed with
biological cyanoacrylate (Periacryl). Figure 3. Occlusal view of #4 in 2006.
Figure 6. Placement of periacryl on grafted
After a five month healing period, a Options were discussed and an extraction extraction site.
4.3 x 10mm. implant (Replace Select, and implant placement were chosen. (Periacryl, Delta, BC, Canada) to form a
Nobel Biocare) was placed and put into matrix for the socket seal procedure (Figure
immediate function with a cemented The tooth was elevated with vertical 6). By not raising a flap, two important
temporary crown. No flap was raised due to angulation of the elevators along the long objectives are achieved: no additional
the abundant keratinized gingiva obtained axis of the tooth, primarily elevating trauma occurs to the delicate buccal plate,
with the presented technique, resulting in a from the palatal and interproximals, and there is a layer of dense collagen
near bloodless procedure. being careful to avoid destruction of the over the socket to serve as a scaffold for
buccal plate (Figure 4). No luxation was epithelial growth to seal the area.
The final porcelain fused to metal cemented performed, and forceps were only used for
crown was delivered three months later, Temporization was achieved by etching
and has been in function for over twelve the two adjacent crowns with hydrofluoric
years. There acid and bonding a composite ovate pontic.
was less than The patient was warned that this may
one mm of
bone apical loosen and to return for reattachment if
to the tip of needed. Ovate pontics have been shown to
the root, so reduce the post extraction dimension loss
3,4
the majority Figure 4. Extraction of #4 using elevator along of bone, both horizontally and vertically .
Figure 1. Radiograph of #4 of the bone long axis of tooth, not touching the buccal plate. To create an ovate pontic the temporary
before loss of post – 1998. supporting crown is inserted into the extraction site
Note perfect interproximal final delivery of the tooth after sufficient with a convex shaped apical end. The
bone levels. mobility was achieved by elevation. No
flap was raised and the buccal plate was

Figure 2. Post had fallen out and been
recemented. Note vertical bone loss has not
reached the adjacent tooth.
Figure 7. Radiograph of bonded temporary.
the implant was grafted bone, showing the apical extent is limited at least 1 mm. away
ability of grafted bone to support an implant Figure 5. Extraction socket with buccal from the bony ridge to allow for formation
long term. plate intact and placement of graft. of a biologic width of gingiva (Figure 7).
kept completely intact, leaving a perfect The ovate shaped temporary supports the
5-wall defect (Figure 5).
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