Re: Bone Grafting Option: Socket Graft

Procedure overview
Placing powdered bone graft material into a fresh tooth extraction site is known as a "socket graft", and is intended to prevent resorption, not rebuild the site after resorption has taken place. Socket grafts are sometimes referred to as "ridge preservation".

The second method of grafting a bone resorption defect is to place the graft material in the site after the resorption has taken place. Depending on the length of time that has elapsed since the teeth were lost, and the size of the resorption defect, your dentist may or may not be able to use powdered bone graft materials to regenerate the lost bone.

What steps are involved
Step 1: Tooth removal
The tooth is removed, leaving an empty extraction site (Figure 3).

Step 2: Bone powder placed in socket
Bone powder is placed into the extraction socket (Figures 4a and 4b).

Step 3: Graft is covered
The graft is then covered with a barrier membrane to prevent downward growth of the gum tissues into the grafted socket, to help contain the bone granules in the socket until clotting adequately stabilizes the graft, and to help prevent gross accumulations of food debris in the site. Frequently used materials for the purpose are "acellular dermal matrix" or "collagen matrix". There are many products on the market for this purpose, about which your dentist can tell you more. An exciting new technique offering promise as a barrier membrane is to use the platelet-rich fibrin (PRF) component of the patient’s own blood, obtained by centrifuging a small amount (approximately 10cc) of whole blood drawn from a vein.

It is important to the success of the graft that good circulation to the area is present (i.e. blood flow). The bone forming cells of the body will use the graft bone as a scaffolding on which to deposit new bone. Ultimately the graft bone will be resorbed away by the body completely, and replaced with the patient’s own bone. About four to six months after the graft is placed, a dental implant can be placed in the site. The graft requires this amount of time for the body to integrate it into the host bone.

If the socket graft is not done following the extraction, a saddle shaped depression in the bone and overlying gum tissues will predictably develop at the site (an example of this is shown in the "Block Graft" section). The size and shape of the defect that develops depends on many factors, including patient age, magnitude of chewing forces applied to the site, the patient’s individual bone physiology, and the amount of time that has elapsed since the extraction.