This month’s newsletter concerns extraction site preservation before implant placement

Premise

If the immediate placement of an implant is not possible (due to size of extraction socket or severe infection) it is important that socket grafting be done. 

This is followed up with either primary closure or a membrane.

History

In the 1980’s and well into the 90’s it was felt that implants should be placed at 12-16 weeks after an extraction.  The rationale for this is that immature bone at this point, is very osteogenic.  As a result, the implant to bone integration is enhanced. This concept is legitimate.  The problem comes in the examination of the structural integrity of the immature bone.

When an area is flapped for an implant, the immature bone, or osteoid, has the   consistency of dense, rubbery-like granulation tissue. Primary implant stability in a situation like this is not possible.  Primary  implant stability at placement is a  prerequisite for predictable integration.  This old paradigm (placement in osteoid) has been replaced by the new paradigm (placement in dense Type I or II bone). Unfortunately, Type I or II bone production may take at least 6-8 months. If a socket is grafted, I have consistently seen Type I or II bone at twelve weeks.

If your patient is to be referred to us for an extraction and implant placement is to be delayed I will always graft the site.   I feel so strongly that this improves the implant success that if an extraction is to be done prior to the patient being referred to us for an implant we will provide you with the graft  material that we recommend.