Acrylic Dressing Replacement (M)

In fact the buccal gingival recession at #31 is associated with cervical caries perforation (Fig.1 P).  The debrided socket is packed with mine-ralized cortical: cancellous mix (50:50) (better using mineralized cortical allograft (future particle size: 125μm – 850μm)) hydrated with ~ .25 ml of .3 mg/ml of rhPDGF-BB (one compo-nent of GEM21S, Fig.2,3).  It is extremely difficult to close the socket opening with buccal defect with Osteogen Plug, 12x12 mm BioXclude and 4-0 PGA suture (Fig.4).  Acrylic dressing is unstable in spite of several reline (Fig.5 A).  Its replace-ment is GEM Cap RCM (regenerative collagen membrane), 9-12 month resorption time, which will be fixed in place with Perio Glue.  Watch Video.  In fact, 2 pieces of the reline dislodge in the 1st 2 days postop, while the whole piece 3rd days postop.  The patient feels better when the acrylic dressing is out.  It appears that the bone graft does not fall out, according to phone visit during coronavirus outbreak.  A third method to close the buccal defect is to make mesial and distal release incisions (Fig.6) and transfer the flaps (Fig.7).  In fact the bone graft gets lost, revealed over phone.  Immediate implant is the most secure method to keep the bone graft.  The fourth way is to place Cytoplast, which is fixed with spacer and periodontal dressing.

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Xin Wei, DDS, PhD, MS 1st edition 03/18/2020, last revision 09/19/2020