Extraction Site Grafting

Patient communication
Indications
Grafting materials
Healing time
When can implants be placed?

Patient communication
Extraction of a tooth consistently results in bone and tissue loss. This can create a poor site for implant placement or poor tissue architecture for pontic and other forms of prosthesis. Extraction site preservation grafting is the standard-of-care to preserve bone and it must be communicated to all patients having teeth extractions. Prepare your patients adequately by discussing the purpose and benefits of grafting as well as the possibility of grafting being necessary, which many not be determined until immediately after tooth extraction.

Indications
Extraction site preservation grafting is indicated in the following circumstances:

  • Presence of obvious bone loss from infection or periodontal disease.
  • Complicated extractions requiring significant bone removal during extraction.
  • When implant replacement is planned beyond three months after extraction.
  • Maxillary anterior incisors — he buccal plate of bone is very thin and, even if present, it consistently undergoes resorption. Grafting is indicated in almost all extraction sites in the smile zone.


Grafting materials
Bone grafting materials include autogenous bone harvested from the patient, bovine derivative bone (xenogeneic bone), demineralized, freeze dried bone (allogeneic), and synthetic bone, along with either resorbable or non-resorbable membranes. Growth factors such as platelet rich growth factors or recombinant human bone morphogenic protein materials (rhbmp) may also be used in certain grafting procedures. Bone grafting materials are safe and non-pathogenic.

Healing time
Depending on the site, size of defect, and materials used, bone maturation and adequate healing may take up to four to six months.

When can implants be placed?
Dental implants may be placed four to six months following extraction site preservation grafting. The exact timing is determined upon the size of defect, type of materials, and patient’s healing potential.