Extraction of 25 and bone graft?

This is a 34 yo male whose referring doc requests a consultation for bone block and extraction of #25 for future implant. The patient had RCT #25 5 years ago. Recent infection. Exam showed buccal erythema/edema/abscess.

I traditionally have extracted tooth with socket preservation bone graft. I find these areas do not hold bone graft well and prognosis for future implant marginal.

Have you ever extracted tooth and placed a bone block graft AT THE SAME TIME?

Any other thoughts on this type of case? Thanks.

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6 Comments on Extraction of 25 and bone graft?

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Dr Zoobi
7/10/2020
Your best chances of preserving interproximal bone and tissue is immediate load implant and bone graft. Bucal plate is already gone and gaining vertical height is almost impossible. Some may disagree. My biggest concern with multiple stage surgeries is risks vs benefits to adjacent teeth and tissue. Nice case. Thanks for posting.
Frank
7/10/2020
Extract tooth, put à 3mm to 3.5 mm diamètre implant, healing abutment, GBR with collagen membrane.No need for a block. Easy and predictable.
Liane G
7/10/2020
I would go with socket graft. Extract tooth, cut the root off to bond the crown to the neighbouring teeth, graft with b-TCP + A-PRF, anterior narrow Ti-PTFE membrane 4-5 weeks in situ and place a 15mm implant 4-6 months later with provisional crown and mature soft tissues.
Ahmed Alzahrani
7/10/2020
We need to see the level of interproximal bone at the extraction site and the soft tissue biotype. If they r in good level and thick gingival biotype, i think the use of none resorpable membrane and using mixed of allograft and xenograft will give good result
bzeytin2000@yahoo.com
7/13/2020
This part of mandibula is very compact bone and it can only hold aotogenious bone graft which must be fixed by screws and a good membrane .The first thing to do I think is to treat the infection extract the tooth let the tissues heal and then do the augmentation please.Never ever do immediat implantation in an infected socket. Good Luck
Implant Gal
8/3/2020
I have had good experience by raising a flap, using allograft bone to restore the buccal plate, and a combination of a Resorbable collagen membrane followed by a Non Resorbable synthentic membrane. No primary closure. Suture and leave non R membrane for at least 4-6 weeks. Re enter 4-6 months later and place implant. Socket graft alone will not work due to the loss of the buccal plate, you need a GBR (which is differrent that a socket graft). A combo of allograft and autograft will also work great here.

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