Topic

[Surgery]  Question regarding 14 socket grafting


 

 

Hello Dr. Kwon and Dr. Jin,

 

I have a question about the socket bone grafting I am planning for a patient's tooth 14, which has a fracured root.

 

Questions:

 

1) Can I use the PRF only for the grafting. If I need to use other bone materials in combination, what are your recommendations? (bands, bone type, size...)

 

2) Do I have to thoroughly clean up the socket after the 14 extraction, even if I am planning to use PRF? Do I need to worry about the perforation while cleaning the socket?

 

3) Can I use the PRF 'Membrane" only for the closure?

 

Thanks for your time.

 

 

Best,

 

Edward


by Edward Zhang at Fri, Dec 2, 2011 5:48 AM

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Mark Kwon Replied at Fri, Dec 16, 2011 9:11 PM

Hi,Edward, Thanks for your post. My tx plan would be: - PRF plus particulate allograft (cancellous) mixed together to provide more rigid structure - YES, you would want to clean the best you can - Re-assess in 4 month with updated CT scan - May need to wait longer before placing implant I would definitely use PRF in these cases. - mark



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Bernard Jin Replied at Fri, Dec 2, 2011 9:20 PM

Thanks for your question. Normally you can use PRF alone as a socket preservation material. BUT in this case, the fractured tooth has been present for a long time. This has led to substantial bone loss in all dimensions. So, in this particular case - the answer is no. The PRF cannot be used as the sole technique here since you in essence have a 2 walled defect or worse. You would need to incorporate a membrane barrier technique of sorts - with an ability to reconstruct the three dimensional aspect of the ridge. Alternatively, you could extract, let it heal and consider sinus grafting if esthetics is not demanding (you may need to perform CTGs for esthetic reasons). In this situation, you are looking at vertical alveolar ridge augmentation. Growing bone vertically can be challenging. It depends on your experience, previous training and comfort level. If you choose to perform a graft at the site (and I'm assuming you have taken the advanced grafting course), , I suggest extracting the tooth and debriding the site. Let it heal for a few weeks. Then return to perform your graft (be it a block, particulate or combination (with our w/o PRF.) Alternatively you could use a Ti-reinforced membrane to preserve your ridge form. Again - plenty depends on your training, experience and comfort level. :) YES! You absolutely HAVE TO debride the site after the extaction.. PRF or no PRF - the surgical principles still stands. Please remember - PRF is not a magic bullet. It is a technique that facilitates and promotes wound healing. If you are concerned about perforating into the sinus during the debridement (which I doubt will happen easily in this case), then may I suggest referring the case. If you have taken the advanced grafting course - you would know how to handle a perforation into the sinus (should it happen). You CAN use PRF for closure of the of the site - but proper debridement is necessary, so is proper flap design and site closure. Again - PRF is not a magic bullet and proper surgical principles must be adhered to. I hope the above have helped answer your questions.