We had a difficult extraction on tooth #14 w curved roots and bone like oak. after retrieving root tip we grafted- there was partial loss of buccal wall- grafted with collagen membrane on buccal and allograft covered with cytoplast membrane and sutures-
pt forgot to stay away ripped out sutures, and displaced our cytoplast membrance with wash out of some graft material and exposure of bone in socket.
How would you manage?
regraft now. place allo/xeno graft, cytoplast membrane. secure w/ 2-0 PTFE sutures.
leave for 6 weeks. then remove sutures and membrane.
or you can wait till all soft tissue closed and healed. which is around 1 month.
then do a sausage GBR Urban method. AUTO/XENO/RPM (Geistlich)/ptfe sutures
then give it 6-9 months to grow bone. then return to place implant.
looks like you have around 10mm of sinus floor to place a good size implant.
BTW, consider using the Cytoflex Tefguard membrane instead of Cytoplast. It has better attachment. Cytoflex Tef- Guard is a microporous ePTFE membrane (not to be confused with the old style ePTFE, this is different, it’s microporous). The membrane was developed with proprietary micro pores that were designed to allow nutrient permeation and at the same time prevent penetration of soft tissue and bacteria across the membrane. The combination of nutrient diffusion and the micro porous texture enhances soft tissue attachment while preventing dehiscence occurrence. You can learn about it here: Cytoflex Tefguard PTFE Membrane: Textured
Wait a couple weeks until you have enough soft tissue and regraft, at this moment you dont have enough tissue for tension free closure, thats why your suture ripped
