Socket Preservation and Implant Insertion in a Smoker With a 10-Year History of Bisphosphonate Use: A Case Report

Abstract

A 63-year-old woman was seen as self-referred at the School of Dental Medicine, State University of New York at Buffalo, for the evaluation and management of a root perforation on a maxillary premolar (or bicuspid). The tooth was diagnosed as untreatable and extraction was indicated. Simultaneously, the patient was advised that tooth number 14 was missing and offered options for replacing the missing tooth. The patient was informed about the risks associated with both smoking habits and bisphosphonate intake. Amoxicillin was started the day prior to extraction and continued for 10 days. The tooth was extracted without raising the flaps, and the socket was degranulated and filled with calcium sulfate (DentoGen) and 50% cortical/50% cancellous bone allograft (AlloOss). The orifice was protected with a collagen barrier (Conform). The patient applied chlorhexidine over the wound site (bid) for 14 days; follow-up visits were at 2, 7, 14 and 21 days. Although the patient continued smoking, healing was uneventful. After 4 months, 2 implants (Nobel Biocare) were inserted to replace missing teeth. The full thickness flap was raised and completely repositioned after insertion. Healing was uneventful. Three months later, implants were exposed using a diode laser and were prepared for restoration. Implants were clinically stable and no soft/hard tissues deficiencies were noted. This clinical case may indicate that a minimally invasive surgical extraction combined with regenerative techniques and antibiotic/antimicrobial therapy, followed by implant placement with complete wound closure, may be considered when treating patients with known health risk factors.