Hi lin,

You are correct! It is not ideal to place bone graft material in a surgical site that is infected. The risk of graft rejection and further infection is elevated under those circumstances.

The oral surgeon can only determine the health of the bone when he removes the tooth and debrides the bone. If he sees that he has achieved an adequate debridement with a healthy blood flow and can feel adequate solid bone, he may chose to place the graft at that time. If those conditions are not evident, he may chose to close it up, let it heal for a few weeks and then reopen the area to place the graft.

The idea is to place bone graft material inside of healthy bone. My suggestion is to make it perfectly clear to the surgeon that you do not want any grafting done at the time of the extraction if there is any doubt about the health of the bone. You would prefer to wait and have a second surgery for the grafting. Just so you know, the second surgery is a minimal procedure if done a few weeks post op extraction. It basically goes like this.... Anesthetic is given... a small incision is made over the surgical site... the bone is scraped to remove any residual debris and to encourage a healthy blood flow... copious amounts of saline are used to irrigate the site..... the graft material is packed inside the socket.... a collagen membrane is placed over the graft... and the gum tissue is closed over the site. The recovery is usually not that bad, just a little sore for a few days.

If you feel more comfortable getting a second opinion, then by all means do that. I cannot stress enough that it is the patient who will direct the course of treatment in most cases..... meaning, if you say you want it all done at one time because you are not going to have a second surgery... that is what will be done. If you say you are most concerned about the health of the bone and want the healthiest outcome, the surgeon will take that into consideration.

I hope this helps....
Bryanna