Socket preservation - late implantation

  • Socket preservation for late implantation
    Fresh extraction socket
  • Socket preservation for late implantation
    Filling with cerabone® and closure with Jason® fleece
  • Socket preservation for late implantation
    Gradual regeneration fo the socket
  • Socket preservation for late implantation
    Preserved shape of the ridge after 6 months
The alveolar socket is lined with bundle bone—cancellous bone, into which the periodontal fibers infiltrate. This bone is supplied with nutrients by the periodontium and, therefore, resorbs after tooth extraction. In the case of a thin buccal bone, the whole buccal wall may resorb. Socket filling with a bone graft material may not prevent resorption of the bundle bone, but surely helps maintain the volume of the alveoli, thus enabling a later stable implant placement and improving the aesthetic outcome of the final prosthesis. When performing a late implantation, the use of a slow resorbable grafting material, such as cerabone®, is recommended to obtain a long-term stability of the socket volume. This is of particular importance, if the point of implantation is unknown or if a conventional restoration is planned.

Regeneration time

A healing time of at least 6 months is recommended before placing the implants; this ensures a stable integration of the particles. An earlier re-entry is feasible if cerabone® is mixed with allogenic granules (maxgraft®) or autologous bone chips.

Socket covering

If the bony walls are intact, the application of a barrier membrane is not necessary; however, socket covering is recommended when working with grafting materials. Jason® fleece helps prevent the migration of particles and protects the socket.

Extraction socket with intact wall

With the aim of supporting an optimal formation of new bone, cerabone® granules may be mixed with allogeneic bone (maxgraft® granules); this approach combines the advantages of both materials (i.e., the biological potential of the allogenic material and the long-term volume stability of bovine bone), resulting in a fast regeneration and formation of vital, strong bone. When long-term stability is not necessary, a valid alternative to this approach is the use of synthetic bone-paste maxresorb® inject. This putty can be easily applied into the socket, and its unique composition, based on a nano-hydroxyapatite gel, promotes osseous regeneration. Another alternative, which also ensures an easy handling, is the use of collacone® max. This cone, made of a composite material of biphasic CaP granules bound in a collagen matrix, can be easily applied into the socket with tweezers.

"Socket preservation" typically refers to the filling of a socket with intact bony walls. In this case, the additional use of a membrane, such as collprotect®, albeit not necessary for the osseous regeneration, supports the stabilization of the the material and prevents its migration into the oral cavity. This is particularly important in those instances in which the socket cannot be closed by the mucosal flap. With the purpose of socket covering, the Jason® fleece represents a more cost-effective alternative to barrier membranes. The collagen fleece protects the socket and grafting material, supports wound healing, and may be left exposed for open healing. Another valid solution is to close the socket with mucoderm® (Socket seal technique).

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