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Bone graft at the time of implant placement or earlier?

Last Updated: Aug 14, 2018

I extracted #23 around 5 months back. I am getting conflicting advice regarding whether to graft at the time of implant placement to improve the emergence profile or graft earlier and then later place the implant.

1) Can it be deciphered through the CBCT(Hounsefield units) that the healing socket still has got some soft tissue or is it pure bone?
2) I want to lay a flap although using a guide to add (autogenous bone + Bio-Oss+ Bio-Gide) graft to the implant site 23 to improve emergence profile. What precautions should I take and how should I approach the case?
3) I am being told that laying a flap rather than doing it with a keyhole technique [without laying a flap] will impair the blood supply to the site (extraction of tooth 23 five months prior) leading to complications like graft or/and implant failure. Is that right?

8 Comments on Bone graft at the time of implant placement or earlier?

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Amit Binderman

8/15/2018

If you still have that #23 that you've extracted from a few months ago, consider using that tooth as your graft material. Not only it is the same as autogenous bone (BMPs, GFs and all), but since dentin resorbs slowly it will also act as an excellent bioactive scaffold, so you won't really need the Bio-Oss. Also, the dentin will ankylose to the site bone, so you will get faster bone regeneration, more site stability and great vertical management. Just a suggestion.

Dennis Flanagan DDS MSc

8/15/2018

1- CBCT HU are an indication but not extremely accurate 2- It would be better to split the ridge flaplessly if you have enough experience and training, thus bending the facial cortex to provide 2mm of bone 3- Flaps cause some bone loss, but you can only do what you can do or refer the patient to a clinician who is able. Grafting, bone and/or gingiva, is generally best done at the time of extraction

mak

8/16/2018

Thanks for your input Doc!

Peter Fairbairn

8/16/2018

Depends if you want to help the host regenerate bone ( as only it can do this ) or merely integrate some foreign material to create a bulk of something hard for aesthetic reasons . As this is what I think you want to achieve ( with use xenograft ) then best to graft earlier , wait 6 months and place into new hard matter . If planning to work with host healing and regenerate bone then we prefer with early delayed implant placement as per my Pubmed protocol . This entails the the use of synthetic materials with osteo-inductive potential and the placement of the implant , both of which up-regulate the host healing for true regeneration which is further improved using earlier loading . Regards

mak

8/16/2018

Thanks a lot Doc!

Lads

8/16/2018

Dr. Fairbairn, Could you please provide link or more info on Pub Med article you cited in your reply?

Peter Fairbairn

8/17/2018

Hi Just look under my name in Pubmed , on an open access site to share easily. Regards

Dr.LD

8/17/2018

Without a flap can not be done. Everything else depends on the operator's experience.