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Expert Recommended Protocol

Socket grafting (single or multiple extractions) when the
buccal plate is missing and the bony walls frame exists:
  1.  Before Flap reflection perform short mesial oblique vertical incision (up to 2 mm into the mobile mucosa).
  2. Raise full thickness flap, minimally as needed to expose the entire defect – (Do not perform any manipulation to get tension free flap. No horizontal dissection release cuts, and no brushing. the flap should be with tension during closure and not tension free).
  3. Extract the tooth and prepare the site for grafting.
  4. Cement application 
    * Eject the cement into the site. 
    * Place dry sterile gauze and press firmly for 3 seconds on the buccal and occlusal aspects 
  5.  Reposition the flap for maximal closure by stretching it directly above the cement (exposure of 2-3 mm is fine, but no more than that).

Socket grafting when the buccal plate is missing protocol

Clinical Case Study - July 2018

Extraction of an upper canine with loss of the buccal plate by using Bond Apatite®

  • Following the extraction an implant is placed with atisfactory initial stability. The deficient bone was augmented with Bond apatite bone graft cement.
  • The augmentation technique with the help of cements is simple and evident in the surgical protocol, the deployment of the material as well as in the flap closure.
  • For the purpose of flap elevation, two vertical releasing incisions were made medial and distal to the buccal bony defect. The incision is initiated from the cervical area and are carried through the non movable and up to 2-3mm in to the movable mucosa. The reflection of the flap is to exposed the entire defect in need of augmentation. Following the site exposure, removal of the tooth and debridement of the area, the implant was inserted. Primary stability is ascertained and is immediately followed by injection of the cement directly over the implant and host bone. The cement is adapted in to place by direct pressure for, no more then 3 seconds, using a sterile gauze pad. The flap is stretched to achieve maximal closure and sutured.
  • In this case immediate load of the implant was done by attaching an acrylic provisional crown free of any occlusal and lateral contacts.
  • Three months post-op impressions were taken for a final restoration

Clinical and radiographic views prior to extraction

Clinical view following extraction and site debridement

Provisional crown secured. Augmention using Bond Apatite cement

Clinical view one week following surgery

Clinical and radiographic views 6 months post op

Surgery & Documentation: Baranes David DMD
Augma's featured products: 
      Bond Apatite®                                3D Bond™
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P.O. Box 92691
Lafayette, LA 70509