Extraction Followed By Immediate Implant Placement: What Does De-Epithelialize the Extraction Socket Mean?

perhaps the collegue ment deepithelializetion of the border of crater of extraction loci. Inside the crater we speak of decortcation of osseous dura madre. all this to favourite the success of grafting and implant. to assure one more chance i insert in the cavity first pure cristalline cefazoline and then pure cristalline hydrocortison for three o five minutes and then i insert my onepiece implant with graft material.

Perhaps he meant this: to de epitheliaze the socket and decorticate use a #8 surgical length latch hp low speed bur to remove any residual PDM and to open up the cancellous layer. One can de ep surrounding ging with a coarse High speed bur or a blade if necessary, just my 2cents worth.

When I extract, I aggresively currette the site. If it is hard cortical bone, I will decorticate it with a small round bur and place holes. I want blood. That is for RAP. I also take a 15C blade and deepitheliaze the surrounding tissue around the socket to prevent epithelial downgrowth. The idea is for the epithelium to grow across the site, not down into it. This keeps it from doing so.. For what its worth. Bill

if he was talking about extracting teeth with a present chronic infection (granuloma) then he basically means that u have to remove all the soft tissue inside the socket before u place the implant. Any epithelial tissue present within the socket will prevent proper replacement of the graft material by the native bone and at the same time will result in fibrosseous integration(failure). i believe that we should not attempt to place implants in areas of present chronic infection. Even if it works it is too much risk. i beilieve that u should extract the tooth, debride or de-epithelialize or Curettage the socket, place a graft and a membrane (cytoplast works great in these cases as it can be left exposed in the oral cavity) This way u can guarantee the future and long term success of your implant

what is a cytoplast ?

Dear Dr. N., The main criterion in success of a bone graft procedure is tension-free "closure" of the wound borders. If it leaves open, undoubtedly, the procedure will fail. To keep the wound close during healing period, borders should be fresh. If you extract a tooth and placing implant and bone graft immediately, do not forget that the previous "sulcular epithelium" should be removed; because epithelial tissues will not integrate to each other. Instead you should prepare fresh connective tissue to be integrated and closethe wound area. Neda Moslemi

cytoplast is a PTFE non resorbable membrane made by sybron implant solutions co.

Dear Dr It depends on the condition of the extracted tooth if there was deep pocket ,that means epithelial tissues already grown down into the socket(pocket epithelium) or presence of apical granuloma and lastly crestal periodontal fibers and crestal epithelium that was linning the previous sulcus of the tooth at the end of the day we need direct bone to implant contact with no or at least minimal intervening tissues for good osseointegration to achieved