Utilization of Biphasic Calcium Sulfate as Socket Preservation Grafting as a Prelude to Implant Placement: A Case Report
Extraction of the natural tooth may be a prelude to implant placement. This may be done using an immediate placement protocol or require a delayed approach depending on multiple factors that include residual infection related to the failed tooth being extracted, availability of bone to stabilize the implant at placement, or soft tissue issues. Socket preservation is recommended when the delayed approach is selected to create an osseous bed with adequate height and width that can accommodate the implant that is planned.
Radiograph demonstrating failure of bridge abutments related to endodontic failure and periodontal bone loss.
Figure 2. The fixed prosthetic bridge was removed in prelude to extraction of the failing abutment teeth. Figure 3. Following extraction of the bridge abutment teeth, the extraction sockets were curetted and filled with Bond Apatite. Figure 4. Exposed material over 3 mm was covered by a collagen sponge at the mesial aspect and BioXclude at the distal, which was secured in place by sutures to help contain the graft material without primary closure of the soft tissue. Figure 5. Radiograph taken immediately following extraction and socket preservation with Bond Apatite, demonstrating initial radiopacity of the graft material.
Patient returned at 2 weeks after graft placement for suture removal demonstrating partial closure of the soft tissue over the grafted sockets and an absence of soft tissue inflammation.
Figure 7. Radiographs taken at 2 months after surgery demonstrating partial radiolucency of the graft material placed. Figure 8. Patient presentation at 4 months after surgery demonstrating coverage of the sockets by keratinized gingiva and an absence of soft tissue inflammation. Figure 9. Radiograph taken at 4 months after surgery to evaluate the organization of the graft material placed for socket preservation. Figure 10. Second-stage surgery at 4 months after graft placement following flap elevation demonstrating osseous fill of the extraction sockets and a few residual particles of Bond Apatite remaining.
Figure 11. Trephine containing the core sample of healed graft material at 4 months after graft placement. Figure 12. A core sample of the graft material was removed with a trephine at the planned mesial site and osteotomies prepared at the 3 sites with abandonment of the first molar site due to its bone quality. Figure 13. Implants have been placed into the 3 osteotomies and cover screws affixed to the implants. Figure 14. Radiograph immediately after implant placement demonstrating bone contact surrounding the implants.
Figure 15. Histologic evaluation of the core specimen at 40×, demonstrating residual particles of the HA portion of the Bond Apatite (yellow on right side) and young bone in contact with the particles. Figure 16. Microscopic evaluation of the core specimen at 200×, demonstrating residual particles of Bond Apatite (yellow on right side) HA and young bone (blue on right side) in proximity with the particles and fibrous connective tissue (purple on right side).
Figure 17. Radiograph at 4 months after implant placement and 8 months after graft placement demonstrating bone in contact with the implants and no observable graft particles noted. Figure 18. Radiograph at 6 months after implant placement and 10 months after graft placement at insertion of custom abutments demonstrating bone in intimate contact with the implants and an absence of graft particles observable.
Contributor Notes