Socket Grafting Procedure

Overview

  • Primary Outcomes

    Before you begin: Socket Grafting is a surgical procedure performed after dental extractions. The aim of treatment is to:
    1) Minimize external resorption
    2) Promote bone remodeling and formation
    3) Support future implant placement
    4) Improve restorative and esthetic outcomes

Armamentarium

Instruments and Materials

Video

Procedure

A
B

Clinical Note: Change your gloves after opening the packaging or have an ungloved assistant open the packaging. 

C
D
E

Instrument Options: Minnesota, intraoral mirror

 

F

Clinical Note: It’s important to have your assistant ready with surgical suction during irrigation to capture saline and  debris, keep the site clean, and maintain visibility throughout the procedure.

G

Tip: Insert the tip of the curette into the deepest portion of the socket and apply gentle pressure as you glide up toward the crestal bone. Continue this motion circumferentially in the socket.

Note: Granulation tissue and infected bone will feel tacitly different than healthy alveolar bone, which is hard relative to soft tissue and infected bone.

 

Instrument Options: Lucas surgical curette, Molt curette

H

Tip: Using your non-dominant hand, or ideally with the help of your assistant, position the graft material near the socket area.

Optional: With your dominant hand, hold the graft packer to stabilize the material during loading.

 

Instrument Options: Surgical curette, Spatula, Graft Packer

I

Tip: Rotate the instrument gently to adapt the graft material to the socket’s contours.

Clinical Note: Between adding and packing more graft material, use a 2×2 dry gauze to gently compress the area. This helps ensure the graft material is securely packed while also keeping the extraction site clean of excess fluid.

 

Instrument options: Graft packer, Surgical curette, Spatula

J

Tip: Ensure you have identified the “active” side of the membrane prior to trimming, according to the manufacturer’s instructions.

Note: The membrane should constrict mesio-distally and extend slightly beyond the edges of a socket. It will resemble an hourglass or rounded square for posterior teeth or ice cream cone for anterior teeth.

 

Instrument options: Scissors, scalpel

K

Instrument options: Cotton pliers, Condenser

L

Instrument options: Tissue forceps

M

Tip: Using a blunt hand instrument, have your assistant stabilize the membrane while inverting the external boundaries of the membrane to avoid dislodgment of the membrane.

 

Instrument options: Tissue forceps

N
O
P
Q

Checklist

References

  • Camargo, P. M., Lekovic, V., Carnio, J., & Kenney, E. B. (2004). Alveolar bone preservation following tooth extraction: A perspective of clinical trials utilizing osseous grafting and guided bone regeneration. Oral and Maxillofacial Surgery Clinics of North America, 16(1), 9–18. https://doi.org/10.1016/j.coms.2003.10.004
  • Block, M. S. (2004). Treatment of the single tooth extraction site. Oral and Maxillofacial Surgery Clinics of North America, 16(1), 41–63. https://doi.org/10.1016/j.coms.2003.10.007
  • Titsinides, S., Agrogiannis, G., & Karatzas, T. (2019). Bone grafting materials in Dentoalveolar Reconstruction: A comprehensive review. Japanese Dental Science Review, 55(1), 26–32. https://doi.org/10.1016/j.jdsr.2018.09.003
  • Joesch, M. (2022, February 1). Guidelines for ridge preservation: When and how. ITI Blog. https://blog.iti.org/clinical-insights/guidelines-for-ridge-preservation-when-and-how/
  • Nrp900Ri22Df. (n.d.). Ridge Preservation (bone grafting) after tooth extraction: When is it necessary?. North Raleigh Periodontics Implant Center. https://www.northraleighperio.com/blog-news/ridge-preservation-after-tooth-extraction/
  • Garashi, M., Klein, A., Suzuki, J. B., & Bronstein, D. (2018, October 17). Alveolar Ridge and socket preservation techniques for implant therapy. Decisions in Dentistry. https://decisionsindentistry.com/article/alveolar-ridge-and-socket-preservation-techniques-for-implant-therapy/
  • Motamedi, M. R. K. (2015). To irrigate or not to irrigate: Immediate postextraction socket irrigation and alveolar osteitis. Dental research journal. https://pmc.ncbi.nlm.nih.gov/articles/PMC4432615/
  • Papadakis, M. (2021). Wound irrigation for preventing surgical site infections. World Journal of Methodology, 11(4), 222–227. https://doi.org/10.5662/wjm.v11.i4.222
  • T., A., & C., J. (2001a). Osteoinduction, osteoconduction and osseointegration. European Spine Journal, 10(0). https://doi.org/10.1007/s005860100282
  • Cornelius Timothius, C. J., Kilic, H. N., Gandhi, K. K., Kakar, A., & John, V. (2023). Particulate Bone Graft Materials for periodontal and implant surgery: A narrative review and case series. Dentistry Review, 3(2), 100068. https://doi.org/10.1016/j.dentre.2023.100068

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