I have finally found an oral surgeon who agreed to pull my root-canaled tooth and am trying to schedule this extraction ASAP, maybe as soon as this Friday. My question is whether this doctor should be the same person who does my implant. I see everyone advertising their implant business now, but I had always thought for some reason that only periodontists did them. I'm wondering what to do now, since I haven't even fully decided whether or not to have an implant and I'm wondering about the preparation of socket (he mentioned bone grafting?) during the extraction surgery. What do I need to know? Bryanna, would love your help here!

Sadie,

Oral surgeons have been placing dental implants routinely for many years. Periodontists have been placing them more recently.... maybe 10 yrs or so.

It is important to discuss with the oral surgeon at the time of the extraction the preparation of the socket for a future implant even if you decide not to have an implant. The bone grafting encourages new bone to grow in that space which is beneficial irrelevant of whether you have an implant placed later on or not. You have about a year to place an implant in newly grafted bone. After that time frame the bone will start to recede if there is nothing in it to maintain the level.

The socket needs to be healthy in order for the bone graft to be placed. If the socket is infected... the graft will also become infected and fail. So the oral surgeon would make a judgement call once the tooth is removed as to whether the graft should be done at the time of the extraction.

Regarding the extraction....
It is imperative that:
The tooth be removed as gently as possible...
The periodontal ligament be completely removed...
The socket and bone be thoroughly debrided of all necrotic tissue and bone.

Dental implants are titanium or zirconium and look similar to small screws. The bone needs to be healthy and plentiful in order for dental implants to integrate properly and healthfully.

Bryanna

Thanks again for your help and patience, Bryanna. I guess that explains why he was unable to say whether or not he would be able to do the grafting at the time of the extraction, depending on what he finds in the socket. Does that mean I would then have to return for bone grafting, then wait another 3 months (or more), then have the implant? And would that separate bone grafting procedure mean opening the socket again? Sorry for all the questions but I am really nervous about the extraction itself (and part one of the resolution of the root canal issue) so even though I thought I asked the oral surgeon every possible question, I guess I missed a few!

Sadie,

If the surgeon feels that the surgical site is not healthy enough to receive the graft, then he will suture it closed and wait a few weeks or so to go back in an place the bone graft. He may see you in between that time to evaluate the healing. It all depends on what he finds at the time of the surgery.

The jaw bone heals very slowly. It takes about a full year before the bone is actually filled in completely. So to go back in to do the bone graft within a reasonable amount of time is not a big surgery.... less surgery than the extraction. Yes, he has to reopen the site and pack the graft into the socket.

The third surgery would be to place the dental implants and that surgery should wait until 4-6 months post op the bone graft. Earlier than that and the graft material may still be a bit mushy.

I hope I have answered your questions okay.... let me know!
Bryanna

That was very clear, Bryanna! Thank you!

Just a couple more if you have the chance:

Does everyone need a bone graft to get an implant? Is it ever possible to have enough bone following the extraction to do implant without grafting?

Does this mean I could have the bone graft and wait up to a year to have the implant?

Just wondering how to get through all this as efficiently (and with as little jaw trauma) as possible. And trying to be more informed than I was before my first root canal!

Hi sadie,

Anytime a tooth is extracted there will be some degree of bone loss. The hole where the tooth was will fill in but not completely. Over time the bone will recede further until the ridge is flat. The bone graft that is packed into this hole will stimulate the growth of new bone to integrate with it. So the graft eventually becomes your own bone reducing the overall loss of bone. In most patients, even if an implant is not placed in this bone, the loss of bone will be less than if no bone graft were placed. Some people will naturally have less bone loss than others..... its an individual thing and is not predictable.

Generally if a tooth was removed due to reasons other than infection or if the infection was caught early on .... an immediate implant can be placed without using bone graft material.

It is "ideal" to have the implant placed within 6 months or so after the bone grafting. This is the midway stage of healing and if it is successful then the implant will integrate nicely with the bone as the socket heals completely over the course of the next 6 months.

Bryanna