Question:

I extracted and grafted this case roughly 6 months ago. To me, the site looks a little odd as you can see the clear delineation between where I grafted and the socket. Is this area ready for implant placement?

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https://s3-us-west-2.amazonaws.com/secure.notion-static.com/1c08b7ed-6d5f-443f-b031-27e254c2af84/Screen_Shot_2021-04-07_at_8.11.09_PM.png

https://s3-us-west-2.amazonaws.com/secure.notion-static.com/45d469d2-2e65-49b2-aa68-807bf2e5b343/Screen_Shot_2021-04-07_at_8.11.22_PM.png

It’s not uncommon to be able to see the graft material on an X-ray for quite a long time especially if you used a xenograft. What you’re seeing is cortical bone particulate in the socket surrounded by native cancellous bone so it makes sense that you’ll see the outline of the socket. Xenografts can stick around for years and years. Allograft will gradually turnover into native bone.

The key to socket grafting is absolute meticulous debridement/cleansing of the socket. Curettes, piezosurgery even sometimes burs to get all the granulation tissue and anything else out. This may be why you see some radiolucency around your graft.

Time to place that implant! 6mo is a long time and I bet that’s good quality gone with possibly a few defects that won’t matter. You’ll get a feel for how hard or soft the bone is by checking the torque value at the end once your implant is where you want it to be.

I don’t expect this to happen but If you get in there and it’s total mush, I’d pump the breaks and start over. Curette all the mushy bone out and regraft.

Remember the most important bone is right at the cortex. If that’s quality then you’re golden.

No better way to see if the bone is ready than to just place that implant!

Also,

I usually wait 3 months after extractions before going back to place an implant. EXCEPT for in the posterior maxilla. The allograft placed in that area just doesn’t seem to turn over (turn into native bone) as quickly and it can remain grainy for a while. So, in the posterior maxilla, I often wait 5-6 months.