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jorbrown posted an update
How do you ensure your graft gets to the apex? I completed site preservation today and it is the first time I have done it since residency (2021). The graft in some areas that you see in the CBCT the graft didnt get to the apex? How will this effect implant placement later on? Do you place a little graft at a time, use perio probe then add more? or just lump it all in there at once? I struggled also with the non resorbable membrane i ended up stuffing two on the palatal (you can see the second one subgingival near the lingual of #2, feedback is appreciated! How do you relief the tough tissue on the palate? Thank you!
barbarios5 Comments-
For grafting I almost only use my curette and place a little at a time. This lets me pack apically as I go. I use cotton swabs for compression too. That being said there’s still been times where I have a 1-2mm void at the apex. Not ideal, but my implants turned out fine
For the palatal release, I do a conservative envelope flap. Same on the buccal. It allows me to tuck the membrane in on both P and B, then I get a little more closure with the sutures
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I wouldn’t worry about the graft getting to the apex, that area will fill with blood and turn into bone. There are even some techniques that use a collagen plug (not osteogen) then granulated bone on top. Still turns out great.
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It’s true, I wouldn’t worry too much about little voids. However, I do like to use something like this to make the transfer of bone easy as well as help reduce my voids: https://www.net32.com/ec/pro-series-bone-grafting-syringe-injector-stainless-d-180931?vid=20756&frt=18&gad_source=1&gclid=Cj0KCQiAvbm7BhC5ARIsAFjwNHvWxFgCirVxnzi22dUq-8ebPpEQhVWSXOkxxtKaGJff7AcdRcRAZBEaAjctEALw_wcB
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I place some with the bone syringe and then i pack it with a condenser. You don’t want to pack it crazy tight as you still want some blood to soak in there.
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I also do a similar process of doing small amounts at a time to make sure I have it where I want it
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