I get calls from friends and general dentists asking me how to manage minor complications during extractions. I realized that this information would be helpful for a broader audience and not everybody is stocking collagen plugs as a part of their armamentarium. A day doesn’t go by in my office that I don’t use these for something. There are several other applications, but I tried to pick the ones that would be most pertinent to you.
What Is a Colla Plug – and Why Keep One on Hand?
Collagen plugs (often called “colla plugs”) are small, bioresorbable sponges made from purified type I collagen. They’re incredibly versatile in periodontal and oral surgery – acting as scaffolds for clot formation, protecting wounds, and aiding soft‐tissue healing. Because they’re biocompatible and naturally degraded by the body, they minimize patient discomfort and reduce chair time. Having a box of colla plugs in your armamentarium means you’re always ready to manage minor emergencies or enhance routine extractions without resorting to more invasive grafts or membranes. The body breaks down this collagen in about 14 days. So, there is no need to remove them.
1. Preventing Dry Socket
After extracting a tooth, debride the socket with a curette. My preferred instrument is a serrated Lucas curette. Place an entire collagen plug into the socket and use a cross-mattress suture over the top. Chromic gut sutures work great. I have taken out thousands of teeth and placed collagen plugs into the sockets, and I’ve never had a case of dry socket when using one. The collagen plug helps prevent dislodgement of the blood clot, which can lead to painful dry socket (alveolar osteitis).
Placing a collagen plug into the socket:
● Stabilizes the clot – its porous structure traps red blood cells and platelets.
● Protects the socket – forms a barrier against irritants like food debris.
● Speeds comfort – patients report less pain and fewer analgesics.
2. Closure of Small Sinus Perforations
Accidental small perforations into the maxillary sinus can occur during molar extractions. When I say “small,” I mean 2 mm or less. If you are taking out a maxillary tooth and notice a perforation through the Schneiderian membrane, a colla plug can be the difference between your patient developing a larger oral-antral communication and achieving good closure after the procedure.
A well-placed colla plug:
● Seals the defect temporarily, preventing oral‐antral communication.
● Facilitates healing of the Schneiderian membrane without requiring a full flap.
3. Managing Sockets That Won’t Stop Bleeding
Some patients (e.g., on anticoagulants or with bleeding disorders) may present with persistent post-op bleeding after extractions. What I like to do in these cases is take my colla plug and inject local anesthetic into it until it is soggy. Then, I place the colla plug into the extraction socket. The epinephrine in the anesthetic helps promote coagulation inside the socket. I refer to this as the “poor man’s Gelfoam.”
Collagen plugs soaked in anesthetic:
● Provide hemostasis by concentrating clotting factors at the site.
● Reduce chair time – quick placement often stops oozing within 5 minutes.
● Stops bleeding by delivering concentrated amounts of anesthetic containing epinephrine directly into the source of the bleeding.
4. Volume Fill When Patients Decline Bone Grafting |
Occasionally, a patient opts out of particulate bone grafts – due to cost, fear, or personal preference – yet you’d still like to maintain ridge contours. This is simple, after you remove the tooth and curette out the socket, simply place the colla plug and do a crossing mattress suture over the top with chromic gut sutures. A colla plug: ● Gives slight bulk to the socket, helping preserve soft-tissue volume vs no collagen plug. ● Supports gingival architecture until natural clot contraction stabilizes the ridge. ● NOT a replacement for bone grafting Studies have indicated that a collagen plug is better at volume stabilization than not placing anything into an extraction socket, but bone grafting remains the gold standard. |
5. As a Protective Layer Over Bone-Grafted Sockets |
When you do place particulate bone graft into an extraction socket, covering them with a resorbable barrier is key. Laying a collagen plug over the graft: ● Secures graft particles – prevents displacement during flap closure. ● Protects extraction sites – blocks food debris from getting in and graft particles from getting out. ● Eliminates membrane removal – collagen plugs fully resorb, simplifying post-op care, no need for expensive non-resorbable membranes. |
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Where do you get them? Most dental distributors sell these. We buy ours from Straumann. We have also purchased them from Salvin. |
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Billing Information
CDT code D7922 (placement of an intra-socket biological dressing to aid in hemostasis or clot stabilization after a tooth extraction, per site) can be used to bill your patient. This is charged in addition to the extraction code. Fees seem to range $40-$60 for D7922.
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Conclusion
Collagen plugs are a Swiss Army knife in your oral surgery tool kit. Keep a supply on hand, and you’ll find countless small but significant ways to improve patient comfort, streamline procedures, and enhance clinical outcomes. They are relatively inexpensive, and I highly recommend you get some!