OsteoGraf ®/LD-300Dennis G. Smiler, D.D.S., Encino, California

Not every patient that pre-sents in my office for a toothextraction is an implant candi-date. Not every patient knowswhat he or she wants to do - orwill do in the future. What theydo know, is they need a toothremoved and they want the besttreatment possible.

Over the past few years, 1have realized the importance ofridge maintenance and preserva-tion. 1 have learned that patientsmay reappear in my office yearsafter an extraction, inquiringabout endosseous implants or,after being referred to me by theirgeneral practitioner, complainingabout their loose and ill-fittingdentures or partials. What 1 havealso leamed is that grafting freshextraction sockets not only main-tains the alveolar ridge, but offerspreservation for future prostheticrequirements.

A 31-year old male patientpresented in my office with afracture of the maxillary rightcentral incisor. After clinicalexamination and radiographs, itwas determined the crown of thetooth was fractured and the rootsurface was exposed in the sock-et. The removal of the tooth wasscheduled, but the patient wasundecided at that time aboutwhich restorative treatmentoption he would accept.Therefore, it was imperative topreserve the ridge and reduce therisk of any bone resorption orloss of dimension.

The maxillary right centralincisor tooth was removed. Thesocket was aggressively curetted

and copiously irrigated(Figure 1). A molt curettewas positioned at the level ofthe mucogingival junction tocheck for fenestration of thebony walls. A large fenestra-tion was detected on the labi-al aspect of the socketincreasing the risk of resorp-tion and distortion to the alveo-lar ridge if left ungrafted.

A synthetic resorbablehydroxylapatite, OsteoGraf®/LD-300 (CeraMed Dental,Lakewood, CO) was used tograft the socket. The graftmaterial was wetted prior toplacement with a sterilesaline solution and packedinto the prepared socket(Figure 2). The material waspacked firrnly but not tightlyallowing for vascularity intothe graft up to the alveolarcrest. To contain the graftmaterial, a small piece ofColla'Iape" (Sulzer Calcitek,Carlsbad, CA) was placeddirectly over the graft mater-ial and adapted to the socketwalls. Since re-adaptation ofthe tissue was impossible, acalcium sulfate material,Capset" (LifeCoreBioMedical, Chaska, MN)was mixed and adapted overthe CollaTape (Figure 3).Although the tissue was notsutured, by utilizing thesetwo containment materials,the risk of graft materiallosshad been minimized.

Prior to the extraction ofthe tooth, a terriporary "flip-per" had been fabricated. The

Figure 1. The socket prepared for grafting.

Figure 2. OsteoGraf ®/LD-300.

Figure 3. CollaTape ® and Capset ® contain thegratt material.

patient was discharged with thetemporary appliance, appropriatehome care instructions, and apostoperative appointment in oneweek.

With the consumer awarenessand popularity of endosseousimplants, the patient returned tomy office approximately fourmonths after the removal of themaxillary right central andrequested additional informationon implants. He was no longersatisfied with the removableappliance. A three-unit bridgewas not the ideal treatment plansince it would involve the prepa-ration of the virgin adjacent teeth.

Treatrnent options were pre-sented to the patient and he elect-ed for a single tooth implant.Since the extraction site had beengrafted at the time of toothremoval, an implant was now aviable treatment modality withoutconcern for adequate bone orcompromised angulation of theimplant.

The tissue was firm andhealthy with the extraction socketdefect eliminated by the bony fillof the graft material (Figure 4). Apilot drill was used to establish theinclination as well as the depth ofthe proposed implant. To deter-mine the correct position of theaxial inclination a parallel pin was

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placed into the osteotomy cre-ated by the pilot drill.Progressive bone-spreadingosteotomes were used to fur-ther develop the recipient siteto accommodate the implant.A 3.8 Steri-Oss implant(Yorba Linda, CA) was posi-tioned so the machine collarwas at the level of the bone toachieve the most estheticresults for the patient (Figure5). The final restoration wasfabricated and cementedapproximately five monthsafter implant placement andintegration (Figure 6).

Although this patienteventually elected for implantrestoration, the ideal recipientsite had been created whenthe socket was grafted with asynthetic, resorbable hydroxyl-apatite. Even if this patienthad not considered implants,the alveolar ridge would stillhave been maintained andpreserved aiding in prostheticretention and function.

Grafting fresh extractionsites has become a routinepart of my practice. Itenables me to offer mypatients a variety of restora-tive options both immediatelyand in the future. '¡

Figure 4. 4 months after extraction and socketgraft.

Figure 5. Placement of the implant.

Figure 6. The final restoration.

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