Extraction for Bruxer

A 56-year-old man with signs of bruxism (multiple occlusal wear and tear, Fig.1) returns from an endodontist office because of failed RCT retreatment at #3 (Fig.2 (* palatal swelling; > fistula)).  After difficult extraction, the socket is large without much septal bone (Fig.3 *).  Because of lack of the apical native bone, immediate implant is not placed.  If it has to be done, a large and long one is required.  Instead socket preservation is finished (Fig.4 *).  The socket is 20 mm deep, while the shank of surgical curettes is 20 mm.  It appears that the most apical granulation tissue is hard to be removed.  When 7-day oral Clindamycin is finished, the patient returns with chief complaint of recurrent pain and fistulae.  In fact the palatal fistulae are flat without erythema.  He returns asymptomatic 2 weeks postop; the fistulae are disappearing (Fig.5 ^) and the socket is healing (Fig.6).

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Xin Wei, DDS, PhD, MS 1st edition 02/21/2019, last revision 03/09/2019