- Before Flap reflection perform mesial oblique vertical incision (up to 2 mm into the mobile mucosa).
- Raise full thickness flap, minimally as needed to expose the entire defect (Do not perform any manipulation to get tension free flap. No horizontal dissection release cuts, and no brushing. the flap should be with tension during closure and not tension free).
- Extract the tooth and prepare the site for grafting.
- Cement application
- Eject the cement into the site.
- Place dry sterile gauze and press firmly for 3 seconds on the buccal and occlusal aspects.
- Press again on top of the gauze using a periosteal elevator in order to compact and compress the cement well.
- Reposition the flap for maximal closure by stretching it directly above the cement (exposure of 2-3 mm is fine, but not more than that).
Socket Grafting With Flap Reflection
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2 Comments
I thought that during the extraction and socket preservation, that if there was a missing buccal plate you were supposed to do a vertical excision and expose the whole defect? The instructions under the video actually show that, but the video does not show a vertical incision and flap reflection. Why the discrepancy? It would certainly be nice not to raise a flap and it didn’t make much sense to be if we weren’t placing a membrane.
In cases of a missing buccal plate, it is recommended to perform one vertical incision and reflect the flap as shown it the video in 0.19 -0.50 seconds. The reason for raising a flap minimally as needed in cases of a missing buccal plate is not in order to place a membrane, which is not recommended at all, but the reason is to expose the area and perform a complete debridement under proper visualization, and to have the ability to compact the cement well buccally and occlusally. In a case where there are 4 bony walls, we don’t need to push the material until the bottom of the socket, since there is the protection of the blood clot by the bony walls. Thus, it is enough that the cement will be well compacted at the cervical level. However, when a buccal wall is missing, the material should be well compacted all way down and slightly overfilled at the buccal aspect and at the occlusal level.