Any thought on how to stage this case? Missing sinus floor concerns me. I’d like the sinus floor back before I graft. I’d like to avoid a long saga of trying to get an oral Antral communication closed. I plan on using prf only in the socket at the extraction appointment…

A collagen plug is perfect to block that communication. PRF has no barrier function, whereas the collagen can help prevent that oral-antral communication you’re talking about.

Personally, I would also graft at the same time as long as you are confident you were able to curette out all the infected tissue. That plug will really protect the sinus.

I would say even with an oroantral communication most of my patients don’t even have any subsequent sinus symptoms– but if it does happen I always tell them to take a decongestant and a nasal spray (like mucinex and afrin).

If you are worried about grafting at that time, you can do a delayed socket preservation. This would include extracting the tooth, putting a collaplug in for the communication, and coming back in 6-8 weeks once the soft tissue is healed to do the socket preservation.