To Graft or Not To Graft?

I was going through cases from when I did my perio residency nearly 20 years ago. I came across this molar immediate implant I placed and I realized how differently I might treat it today. In this particular case I opted to place a graft (Mineralized Freeze Dried Bone Allograft) to fill the space between the implant and socket (Jumping Space). Knowing what I know now about clot stability and wound healing I question the necessity of the graft as it is a fully intact socket. I am just curious as to what others would do and why…

Steven comments:

Not necessary but can't hurt

Implantmike comments:

Beautiful Question. With the advent of growth factors all studies have shown that graft with PRF increase wound healing with volume maintenance. But as we know with every article there are always different opinions but it is clear grafting leads to better volume

Tim Carter comments:

Clear?? Volume of what?? I am still intrigued by Dr. Bill Becker's definition of "osseoinhibition" as he is convinced that most materials inhibit osseointegration and we would be best to allow momma nature to work. I think the unbiased studies demonstrate that grafting is overrated and at best probably just a good source of revenue with no real definable benefit.

Herb Stith comments:

Do you have follow-up pictures or radiographs

ST comments:

IMP experience, having grafted the majority of my immediate cases since 2005, I recently tried a few without and, unfortunately, had bucc bone loss on anterior teeth. No infection, a-traumatic xla, no infection, 2+ mm of buccal bone thickness and fixture at least 2-3 mm distance from it. Good closure. Back to grafting but now only synthetic materials, no human or animal products as more and more evidence points to inflammation/long term graft loss.

Dr Pravin patel Mumbai comments:

Not necessary to graft always..except perforation in walls specially buccal walls.. Main purpose is to protect the clot and prevent contamination with food..can take figure of 8 suture or place healing abutment and cover with flowable composite to keep primary wound un disturbed for first 10 days..than can remove this once primary healing takes place. Hope it helps..Dr Pravin patel Mumbai

Dr Elie Warde DDS comments:

PRF is enough for cases like that. I fill the jumping gap and maintain the PRF graft with criss-cross 4/0 PGA sutures