When the perio dressing is removed, the buccal bone graft is found to have been exposed, which is not abnormal.  What is unusual is discoloration of the graft and that the graft is not so densely aggregated as normal (Fig.14 <).  The significance of the latter is not revealed until 3 months postop when the patient remains asymptomatic, but the apical fistula remains open (Fig.15 <).

A provisional should have been fabricated to keep the exposed graft (possibly infected) in place loosely.  At this moment, the buccal plate is not as concave as that 3 months later.  Graft granules must have been lost from the open gap.

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Xin Wei, DDS, PhD, MS 1st edition 09/20/2014, last revision 01/19/2018