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HANNAH posted an update
Hi everyone,
I got some conflicting advices regarding socket preservation (4 walls are all preserved), and would like to clear it up here once and for all:
The material-
Salvin rep says using the fulfill plug- 80& synthetic calcium phosphate granules with 20% bovine collagen is sufficient. Bone will turnover in 6 months and become ready for implant.
On the other hand, my neighbor periodontist says to use allograft for best bone quality, for implant. And that the plug should only be reserved for bridge pontic sites. (side question, if allograft is indeed the best, what ratio is the best?)
The covering-
Salvin rep says if I use allograft, I have to cover it with a collagen membrane that resorbs in 4-8 weeks. If I use the fulfill plug then no membrane is required.
I thought using a collagen tape that resorbs in 10-14 days are sufficient in both allograft and plugs.
The suture-
I personally like to use non resorbable suture. I know non braided types can attract less plaque. Do you guys have a recommended material?
Thanks y’all. If there are some resources or papers on this, please guide me to it as well.
Jedediah5 Comments-
I use allograft 50/50 mix for all my socket preservation, membrane depending on if there are any Boney wall defects as you eluded to. For simple sockets 4 walls a lot of times flattening a collaplug or the like material into the shape of the socket outline, placing it over the top and a figure 8 suture will do fine. Some folks don’t even cover it and just suture it down.
When I started out I used Monotex PTFE sutures a lot only because I wanted to see them back at 3-4 weeks for an eval and suture removal. Still do depending on how it goes 😑 Namely learning and seeing how my sutures hold up during that initial healing phase. Now I use chromic or glycolon a lot.
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I immediately thought of you @restoredsmiles as I believe you’re teaching a grafting course in march right?
What are your thoughts on plug vs allograft.
In your opinion, Does it matter too much in a case where all 4 walls are intact?
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Thanks Ivan. Yes you have a great memory. I do have a bone grafting course coming up on March 16th at our Restored Smiles Ranch teaching facility. It would be great for many of the docs to address many of these matters and improve techniques and I have a few special scholarship funds set aside for a few doctors that cover 1/2 the cost of the course with a few seats remaining so if anyone would like just reach out to me and I can give you more information but I don’t want to Bother you with any details here.
It’s a zero defect site. It’s definitely not as technique sensitive and you do not need to barrier membrane If you do not create a full thickness flap and try to get primary closure. We’re not trying to get primary closure and we don’t want primary closure with a simple socket preservation? We want to heal with secondary intention and we will get more keratinized tissue.
If you do use bovine bone, you should definitely allow the patient to heal longer as it does take longer to turn over and some does not fully turn over.
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Great questions. I would definitely direct you to our study club webinar that we had in January as the main topic was bone graft materials and we discussed socket preservation and we had very similar questions so that would be very helpful. It’s just about an hour or so. Any materials can work, but I would definitely prefer allograft as I’m not a big fan of bovine bone, as it takes forever to turn over and some never does. I typically just use mineralized, cortical, particulate, allograft, very inexpensive and predictable. If it’s a simple socket preservation with all walls intact, using that graft and then some collagen tape on top, I just last 10 to 14 days is more than sufficient. We do not need a barrier membrane unless you were doing a large ridge augmentation typically.
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Thank you all for answering! I will definitely look into the study club webinar and the the bone graft course.
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