How to Close Buccal Apical Soft and Hard Tissue Perforation?

A 84-year-old man has upper right discomfort.  Exam shows #4,5 residual roots have percussion pain, while the apex of #4 is buccally exposed (Fig.1).  After extraction of #4 and 5 and debridement, collagen plug is inserted to the buccal defect.  Then cortical allograft is placed in the sockets and covered with 8x8 mm BioXclude.  The wound is approximated with 4-0 PGA suture.  With use of BioXclude, the bone graft appears to remain in place 8 days postop (Fig.2,3).  The apical perforation at #4 seems to be healing (Fig.2 >).

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Xin Wei, DDS, PhD, MS 1st edition 03/23/2021, last revision 03/31/2021