How to: Graft an extraction socket

Socket grafting is an increasingly common procedure. Current conventional wisdom is that the extraction socket should be grafted irrespective of whether a dental implant placement is planned. Socket grafting helps to maintain the ridge by regenerating new bone. The result is better both functionally and cosmetically.

DentoGen^® is a medical-grade calcium sulfate hemihydrate-based bone graft material developed and sold by Orthogen LLC. DentoGen is indicated as:

• a bone graft by itself

• as a mixing agent with other bone grafts

• as a barrier to prevent ingrowth of soft tissues

Versatile material

Although DentoGen is approved for use as outlined above, it works best as a bone graft by itself in smaller defects such as incisor or premolar extraction sockets (any defect smaller than a premolar extraction socket). In larger defects, such as molar extraction sockets, the material works best in combination with other bone grafts such as allograft.

Packaging

A box of DentoGen contains two patient-specific kits with two grams of calcium sulfate material-one gram of material per patient-specific kit-regular set solution (normal saline), and fast set solution (4% potassium sulfate). When the regular setting solution is added to the DentoGen powder, it forms a putty that can be implanted into the bone defect. DentoGen also can be mixed with the fast set solution to form a putty in an accelerated fashion.

Clinical case

A 78-year-old female patient presented with hopeless tooth Nos. 8 and 10 (Fig. 1). After extensive examination and consultations, it was determined the teeth would be extracted.

01. Both teeth were extracted atraumatically. Fig. 2 illustrates the extraction sockets following the extraction procedure. Implants were not planned for the patient in this case.

02. Use the DentoGen Kit. Fig. 3 shows an opened kit with the powder, regular setting solution and fast setting solution. The extraction sites are grafted with DentoGen to maintain the alveolar ridge.

03. Regular setting solution is added to the DentoGen powder and mixed to form a putty (Figs. 4-5). Fig. 6 shows the resulting moldable putty of DentoGen.

04. The material is placed in the extraction sockets layer by layer. Rather than filling the entire extraction socket with one bolus of DentoGen, it is applied in at least 3-4 layers to achieve better bone regeneration (Fig. 7).

05. The extraction sockets are slightly overfilled in layers with DentoGen bone graft material (Figs. 8-9).

06. After both sockets have been filled, mattress sutures are placed to contain the graft. DentoGen also acts as a barrier, which is a plus, and the fast set potassium sulfate solution can be applied after suturing to shorten the setting time (Fig. 10).

This socket grafting technique offers an alternative to bovine xenografts and human allografts in certain clinical situations. It aids in bone regeneration by the conversion of calcium sulfate hemihydrate into calcium phosphate, which is a principal component of human bone.