Socket Graft Plus vs Allograft

Many patients who receive a bone graft will delay implant placement under the assumption that the bone graft will maintain the area for whenever they choose to have the implant placed. When this happens, it gives us an opportunity to evaluate how different types of bone grafts, like allografts and synthetics, perform over time.

In the first case, a patient had an extraction of a lower molar and the site was grafted with Socket Graft Plus. At the time of the extraction, it was noted that the buccal wall was missing. Socket Graft Plus was chosen as the graft material because it contains our 3rd generation beta tricalcium phosphate. The βTCP will not resorb until it is surrounded by bone. This maintains the volume of the socket until bone forms and the buccal wall is regenerated.

The second case is also a lower molar that was extracted uneventfully and the socket was grafted with mineralized freeze dried bone allograft.

Case 1: Socket Graft Plus

Pre op radiographs with missing buccal wall that was grafted with Socket Graft Plus.

3 years after extraction and grafting with Socket Graft Plus the clinical photograph shows some resorption of the buccal crest.

The radiograph shows dense mineralization and good maintenance of the crestal ridge 3 years after grafting.

The ridge grafted with Socket Graft Plus shows some resorption of the buccal ridge after three years, but there is still adequate ridge width and height for ideal implant placement. A few graft particles remain after 3 years as seen on the mesial buccal. Complete resorption of the particles often does not occur until the area is loaded and bone remodeling occurs.

Implant placement

Day of implant placement. A 5.4 x 11 mm Astra implant was placed.

The site was closed with sutures and bonded with Oral Bond adhesive.

Case 2: Allograft

In this case, the molar was extracted and grafted with mineralized freeze dried bone allograft 2 years prior to this photograph. As you can see, both the buccal and lingual ridge have resorbed.

In this radiograph, the site is poorly mineralized without a normal trabecular pattern to the bone. The crestal bone is lost. Contrary to common dogma, no mineralized cadaver bone graft is ever resorbed. So how can the ridge lose so much volume if the bone graft is never resorbed?

The loss of volume occurs because while cadaver bone grafts are never resorbed, they do exfoliate. Cadaver bone grafts are rejected just like other transplanted organs. In the radiograph above, the bottom arrow is pointing to an area in the bone surrounded by a radiolucent border. The radiolucent border is a hyper vascular area surrounding the sclerotic bone. The sclerotic bone is being pushed out to the ridge. The arrow in the gingiva is pointing to cadaver bone granules that have been pushed out of the ridge into the gingiva. Upon inspection of the gingiva, there are other areas for exfoliating cadaver bone graft particles.

The arrows in this photograph above point to areas in the gingiva where allograft particles are exiting the gingiva. This case requires ridge augmentation prior to implant placement. The patient was told that our office is not willing to place an implant in this ridge and the cadaver bone graft would need to be removed and the ridge augmented with synthetic resorbable graft materials. She was also given a referral to another surgeon for a second opinion who might be willing to graft over this ridge and then place an implant.

These two cases are representative of how both materials perform over time. The regeneration of healthy vital bone with Socket Graft Plus will remodel when loaded and likely function for the life of this patient. Published studies have shown that when our technology is used, we have 100% implant success rate after 3 years of function.

There are no studies on the implant success rates for allografts or Bio-Oss.


American Society for Bone and Mineral Research (ASBMR)

Tissue Engineering and Regenerative Medicine International Society (TERMIS)