Clinical tip: Grafting and suturing techniques following an extraction

This week's clinical tip from CDOCS comes from Dr. Doug Smail, and he's focusing on improving your grafting and suturing game.

You can watch the video with Dr. Smail below. You can also visit CDOCS to learn more, and learn more about CDOCS' hands-on workshops.

Dr. Smail's clinical tip

"Now here we have, and you can see in the mirror shot, a simple extraction of tooth #19. The walls are intact. You can see a little defect in the interceptal bone. That's where I had a pop out of mesio root. And once you've curated the socket and everything's clean, you're ready to place the graft.

"Now as we look a little bit closer, you can see the inner intact buccal wall, so we know everything is all set. Like I said, we get it clean and we're ready for the graft. Now I like to use Ossix Bone. It's been very easy to use. I use the 0.5 size -- the larger size -- cut it right in half, put a half into each root socket. Works great. You just pack it down gently, not too hard.

"And you can see now you've got it compacted in there. It's already starting to hydrate with the patient's own blood. So you don't have to do anything extra there. And now we're ready to suture. I like to put a piece of gel foam. You can also put some collar plug or a membrane over, but you really don't have to use a full membrane for this. So I just use some gel foam. Now to start the suture, this is called a crossover mattress suture. Start from the distal buccal. You go outside to in.

"And then you can see where that needle has come through. You bring it over, you cross it over to the mesial buccal. You go inside to out. Once you pull that through, you're going to do a horizontal mattress now and you go to the distal lingual, bring it from outside to in.

"And then you're going to cross over again from that distal lingual to the mesial buccal, crossing over the top of the gel foam. And that goes inside to out. Now you've got both ends coming through the buccal. You pull them tight, you see the crossover there on top. So that's going to hold everything down and keep it stable, at least through the initial healing period. Once you're happy with that, you go ahead and just tie it tight. And you're all set. And you're done."