Replacement of a Maxillary First Molar: Extraction, Socket Grafting and Sinus Lift (1 CEU)
Following tooth extraction, the natural process of bone healing results in a loss in width and height of the supporting hard tissue. In the posterior maxilla, the proximity to the maxillary sinus provides additional challenges in areas of decreased bone volume. When teeth are present, the roots act like tent poles holding up a circus tent — but once the tent poles are removed, the tent itself will fall. This results in the loss of vertical height of bone in an area of the mouth that has the lowest bone density and takes on most of the occlusal forces. Because maintaining that height of bone is important in positioning the dental implant, grafting the socket becomes a critically important technique.
Bone grafting is possible because bone tissue, unlike other tissues in the body, has the ability to regenerate completely if provided adequate space. Grafting at the time of extraction minimizes bone loss, supports soft-tissue structures, and provides an adequate site for implant placement in 12–16 weeks. Failure to graft can lead to soft-tissue infiltration in the socket, loss of ridge height and width, and 30%–60% bone loss in a three-year period.1 2 3 As natural bone grows, it will generally replace the graft material completely, resulting in a fully integrated region of new bone.4 5
For socket regeneration, a two-in-one technique using the OsteoGen® Plug (available through Glidewell Direct; Irvine, Calif.) can achieve successful sinus tenting in preparation for a dental implant. In most cases, utilizing this material eliminates the need for a membrane. The OsteoGen Plug is an excellent, safe material to use, particularly when all walls are maintained following surgical extraction of nonrestorable teeth.
Ridge preservation following extraction is an integral part of implant dentistry. The OsteoGen Plug is an excellent, safe option when all socket walls remain, allowing for condensation of the available hard tissue and elevation of the sinus floor to accept a properly sized implant for the resulting implant restoration.
Available CE Course
- ^ Kosinski TF. Innovative socket grafting techniques in preparation for dental implants. The Profitable Dentist. 2017 Summer:22-7.
- ^ Tuttle D, Kurtzman GM. Simultaneous sinus augmentation and implant placement. Inside Dentistry. 2018 Nov.
- ^ Misch CM. Maxillary autogenous bone grafting. Dent Clin North Am. 2011 Oct;55(4):697-713.
- ^ Jackson BJ, Morcos I. Socket grafting: a predictable technique for site preservation. J Oral Implantol. 2007;33(6):353-64.
- ^ Valen M, Ganz SD. A synthetic bioactive resorbable graft for predictable implant reconstruction: part one. J Oral Implantol. 2002;28(4):167-77.