Grafting an Upper Molar Socket?

Very very interesting subject. Personnaly, if I can see that for sure will need a open sinus lift to place implants after the extraction I will do a pocket filling with bone colected from a wisdom tooth. If the patient has no 3rd molar to remove, I go for maxila tuberosity. With a bone mill I can particulate the bone. I never use bio-oss or stuff like that when grafting the socket, neither I use membranes. Sometimes I use osteotomes to compact and pressure the bone against the walls of the socket. But if I see that I have a good heigth after the extraction I do nothing. Jose Rosa, Lisbon, Portugal

Here is what I do since I have Southern Implants MAX (AO innovation award winner): 1. Extract molar carefully and try to keep alveolar walls intact. Sometimes it is necessary to remove molars in pieces. 2. Remove the interradicular bone and keep it. 3. Drill with 8mm or 9mm drill for a MAX implant and see if primary stability is achievable. 4. If there, fill bone gaps between socket and implant with bone chips from the interradicular septum or anything else. I prefer Cerasorb 500u. With any grafting go for submerged healing 5. If implant sits well and no grafting is necessary, use open healing or immediate loading. If you believe in it, you can platform switch, it has an external hex. Using these implants makes life so easy for both patient and surgeon. I have placed over 60 MAX in maxilla and mandible and never lost one until today. I doubt that the concept will fly because one can not charge for the grafting procedure. One day we may accept that implants can be shorter and wider. After all they do not have anything in common with natural teeth but the location.

I always graft the socket after extraction. Generally, I approach a maxillary molar in stages. First I would graft the site and repair any potential sinus communication. I prefer Cerasorb due to its radiopacity and ability to assess the sinus floor after four months of healing. I would then re-enter the site with osteotomes and use them to internally lift the sinus, place the implant and graft if necessary. This approach allows for sinus repair and adequate deposition of bone to stabilize the implant. It is predictable, but not the fastest.

I always graft the socket..I use oragraft with ca-sulfate and tetracycline. If i know I'll be placing implant later.......I'll flap it and do primary closure. Internal sinus lift or lateral window lift if needed on a later day. I never have any problem with graft MFDB-oragraft, cheap, easy and get the job done. If you can get primary closure....it will be much more predictable. Infected tissue is the hardest to get ride of....That is why flapping it making it easiler to removed most of the infected tissue.

Thanks for the replies. Sounds like everyone does not see it as a problem when later lifting the membrane during lateral wall sinus augmentation if the floor of the sinus ends up with peaks and valleys from the grafted root forms left by the socket graft. Also, I think in the orginal question it is assumed that the implant would be placed later after socket healing.

I also graft after extraction. I use Puros cortical bone MFDA with membrane. Explain the anatomy to the patient and inform them that an internal sinus lift may be necesary at the time of implant placement. A well informed patient is the best patient. I have never had a patient upset if I tell them the sinus lift is not needed. If uninformed, it is tough to tell them they need the additional sinus procedure at the time of implant placement.

Having done about 25-30 antrial wall sinus augmentations I too have wondered if others find it a problem when elevating the S membrane on the floor above these root form protrusions created from socket grafts. Sure seems to be easier when the sinus floor is flat where nature has taken it's course.

Thinking about attending a Pikos course. Anyone know what implant system and graft material he is using in the sinus?

I cant really give a blanket cover all answer to the question to graft or not to graft in this situation. I view each case differently. If the site will benefit from grafting, i.e. sufficient amount of alveolar bone present with minimal root extension into the sinus, I favor grafting. On the flip side, if minimal amounts of alveolar bone are present with extensive root protrusion into the sinus, i tend not graft and return to the site later for sinus augmentation. This seems to minimize the chance of perforation when elevating the S membrane.

It's a couple of time that I have not received the osseonews. Please send me. Please let me know how can I send my comments and or quessions. Thanks

I will try to graft every time following explanation to the patient. I use only MFDB (Oragraft)at the moment thanks to much literature justification from a very helpful periodontist. I also have started to incorporate Clindamycin into the graft 300mg/2ml. I think the literature shows a 1.7mm overall gain in vertical height from immediate grafting as opposed to doing nothing. Its all about the buccal plate and vertical height. I prefer delayed placement. I like to get at least a 10mm implant in there, preferably a 6 X 10 or 13. I want a few mm of bone over the apex, and a 5mm summers osteotome to elevate and graft 0.5cc MFDB works well for me. Upfracture, place graft, implant and primary closure. Im not in a hurry. So, it will work both ways but this works well for me. More predictable for me. I am not looking into maybe expanding the interradicular bone and doing the entire graft at extraction but i will probably still wait for new bone and good blood supply. Just my thoughts and hope this helps. Bill

I meant to say I AM looking into expanding the interradicular bone. I like the idea of control, no heat, widening and the fact that the expanded bone has circulation attached to it, plus it is host bone and grafting superior to that with host bone closer should mean speedier regeneration where you want it. Just my thoughts. Bill

Thanks Bill, makes sense to me as well.

I had a root canal procedure on an upper tooth. The root cracked and became infected causing a fistula. I had the tooth removed. Ever since, I have noticed my sinusus have felt funny. A plastic piece was made to wear while the site was healing. It would sometimes cause pain and headaches. I have had an implant placed last week and am feeling pressure in my sinuses. What could be causing this?