Socket Preservation Tip
There are two options when performing socket preservation :
1- Without reflecting a flap when there are four bony walls – the clinician can use a collagen sponge to protect the graft.
2- With a flap reflection when there are four bony walls or less
(this can also be implemented when the buccal plate is missing) –
a. Extract the tooth and remove all granulomatous tissue.
b. Create a short mesial vertical incision 1 mm into the non-keratinized (mobile) mucosa (Take notice of vital anatomical structures), and reflect the flap partially until the defect is exposed.
c. Apply the cement into the socket from its syringe, place a dry STERILE gauze and press above, thereafter press firmly for 3 seconds.
d. Hold the flap, with tissue forceps, in its mesial crestal (Superior) corner and stretch/mobilize the flap to close the crestal gap by placing your first suture into the lingual aspect of the socket. Make a distal suture trying to approximate the buccal flap into the lingual aspect.
Thereafter, in the middle between the mesial and the distal suture to close the border of the flap. The middle suture, however, should be loose.
Please remember that crestal primary closure is not mandatory at the crest. 1-2mm opening is ok. However, the flap has to be properly secured on its mesial and distal aspects.