Completely debride the socket. Visually examine the complete socket. Any debris left in the socket can interfere with socket regeneration. The most common debris are remnants of endodontic therapy, granulation tissue and root tips.
Take a radiograph. After the extraction but before placement of the graft take a radiograph to insure the removal of all debris. A radiograph of the extraction socket can show remnants of endodontic gutta percha and cement and also root tips. Even complete visualization can miss socket debris.
A removable appliance should never be placed over a grafted site. Any contact with a removable appliance can pump out the graft material or disrupt bone regeneration.
Prescribe antibiotics. Many practitioners do not prescribe antibiotics after extractions. After extraction, the socket is exposed and the body is often able to control a surface infection. However, when a bone graft is placed, the bacteria in the socket is again enclosed in the body which can make the trapped bacteria difficult to eradicate. If the extraction is simple and no cellulitis or abscess is present, a “preventive” dose of antibiotics is adequate. Under these circumstances amoxicillin 250 mg tid for 5 days has been shown to be adequate to ensure normal graft healing.
How To Avoid Socket Graft Failures
The following are clinical examples of potentially complicating socket regeneration factors:
Tooth #19 is scheduled for extraction and socket regeneration.
The extracted tooth and socket was visually examined without finding the retained endodontic debris.
After removal of the bicuspid no grafting was performed. The site was planned for ridge augmentation and sinus lift and dental implant restoration.
After reflection of the flap the site of the extraction was filled with dense collagen.
Removal of the soft tissue in the socket reveled gutta percha imbedded in the bone as seen in the apex of this socket. The gutta percha was removed with the surrounding bone and grafted with Socket Graft.
The second bicuspid had been removed and the socket was grafted with Socket Graft. The root and socket was examined visually but not radiographically. When the patient presented for implant placement a retained root tip was found covered with dense bone.
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