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Complication – Bone Graft is Exposed – Platelet PRF Treatment

Ramsey Amin DDS

I don’t have complications too often but this is one worth sharing. I did a very large block bone graft in the front of the mouth for dental implants. The bone graft was both vertical and horizontal and gained a lot of volume. The block bone graft was held in by screws which will be removed later. This will yield plenty of bone for two front teeth implants.

Complication – Bone graft is exposed

Her temporary Essix bridge inadvertently put some pressure on the gums after the surgery. You never want pressure on top of a newly placed bone graft ! This happened due to a slight tear of clear retaining part of the Essix bridge on the palate. Regardless, it dug into the gum a bit and exposed the newly healing bone.  Now the bone is showing.  You can see how I had to really adjust the Essix temporary to clear all of the bone that was added.

Series of photos showing bone exposure closure technique -Ramsey Amin DDS

I will describe how I closed this open wound using the patient’s own blood platelets-L PRF. (Leukocyte rich platelet rich fibrin)

Series of photos showing bone exposure closure technique -Ramsey Amin DDS

(PLEASE NOTE THAT THIS PATIENT IS NOT COMPLETE — ONE TOOTH WAS EXTRACTED SO THE GAP IS NOW A TWO TOOTH GAP. I PURPOSELY OVER BULKED AND OVER BUILT BONE SO THERE IS EXTRA TO WORK WITH RATHER THAN NOT ENOUGH. THIS WILL LOOK GREAT ONCE THE IMPLANTS AND TEMPORARIES ARE DONE TO SHAPE THE GUMS. THIS IS A VERY LARGE GRAFT BECAUSE IT IS BUILDING BONE VERTICALLY AND HORIZONTALLY)

Series of photos showing bone exposure closure technique -Ramsey Amin DDS

The proper thing here is not to try to reclose the open wound with stitches. That will often make it worse. Usually a noncritical, more basic bone socket graft may fill in on its own. This one was not doing that even though it started off pretty small! You can see the progression over about 7 weeks that it took to close this hole. At first it was not really present, then they got a bit larger> then it shrank down to where pink gum is covering the bone again.

I am always there for my patients. I will do what it takes to correct this. This can happen with block bone graft or GBR membrane techniques….I do both.

Series of photos showing bone exposure closure technique -Ramsey Amin DDS

What I did was remove a very slight bit of surface bone and drew blood from her right arm. With her own blood draw from the arm, special cells in the bloodstream called platelets are concentrated to make a type of gel/membrane call L PRF. I placed the L PRF on the open wound and stitched a web over it to hold in. Over the course of about 2-3 weeks I saw her back 2 times to repeat the blood draw and add more L PRF under the webbing of special Prolene stitches.

The bone graft exposure closed! Complication solved. It is still a bit immature in this last picture but there is pink gum fully covering the bone which is a great sign! Often I get messages from people worldwide with bone exposed that lost their entire bone graft and had to start all over again. This is a very efficient, natural way to close a wound but it does not miraculously close bone grafts that were done with poor technique.

L-PRF and PRP (platelet rich plasma) outside of dentistry heal up wounds that are taking too long such as people with diabetes have open sores.

Your comments and questions are welcome.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

2 thoughts on “Complication – Bone Graft is Exposed – Platelet PRF Treatment

  1. This procedure looks like my situation because I had my Right front tooth extracted on March 26, 2018 — It has been sucking the bone around it for about 13 years — finally a dentist did a CT scan and diagnosed it as “resorption” — I had felt my gums receding and bone loss many years ago. It was freaking me out — with a weird itchy feeling — hard to describe. Then I had soft tissue grafting to fill in the gums, but it melted away pretty fast. Then I had braces, because my bite was off, and possibly contributing to this problem. After I got my braces off, that front tooth refused to move the whole time — but the rest of my teeth were nicely straightened — but I think the resorption started going faster after braces — and finally I got my tooth pulled, and it had holes inside, and the root looked more like broccoli than a carrot. Now — after having granules bone graft the day of the extraction, it has been growing a larger and larger hole — and freaking me out! My periodontist says it will be able to take an implant, but will also need another soft tissue graft. It feels weird — like I don’t know if the synthetic coral granules that he packed in there are really doing anything — I have to wait till the end of July before I get the implant post. My Dr. says it’s in the process of resorbing the coral granules and finding it’s blood supply. I sure hope so! I practically have no bone at all around that tooth — I am praying that I will be able to have an implant, because this flipper is annoying, and there’s a huge hole over the tooth. What is your suggestion?

    1. My suggestion is that you wait longer. March 26 of this year is not enough time elapsed for the bone to heal. Wait until a full 6 months have passed. Any hole that is exposed along the way must be dealt with closure. I would wait far beyond July! Never Rush a front tooth implant bone graft.

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About Ramsey A. Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.