After Extraction and Bone Graft…The Bone is Showing. Now What? Ramsey Amin, DDS Reviews Options

Exposed bone in mouth after graft

Exposed bone in mouth after graft

You may have had your tooth extracted and a bone graft placed at the same time.

About once or twice a week I get emails from around the world with patients that have had this very common (pre dental implant) procedure.

You may be worried because you can see that the bone is exposed inside your mouth.

You may also be worried because small, hard granules, pieces, or particles of bone coming out of the socket. You see white bone showing.

extraction socket bone graph by Dr. Ramsey Amin, DDSDON’T PANIC!

Socket bone grafting is very common and is encouraged when the outer wall of bone is very thin. The goal is to prevent the bone from shrinking and preserve the bone mass.

Most socket bone grafts have particulated bone added to the socket and are covered with some type of membrane at the same time of the surgery. The bone may be from your own body, from a human cadaver, from a cow or synthetic bone.

The bone on your cheek and lip side of your teeth in general is no thicker than 0.5mm to 2 mm at the most. When a tooth is extracted, the thin wall of bone will naturally collapse inward leaving a depression indent in your jawbone. It is that very same bone that you need to have a dental implant.

Ideally over the course of the first week, the gum heals over the top and no bone is showing at all. It is not uncommon for some bone to become exposed during the process of healing. It is also not uncommon to have some of these granules come out during the healing process.

I strongly encourage antibiotic use during most socket bone graft procedures as this will help reduce (not eliminate) the chance of infection. I routinely administer antibiotics right before your appointment so that the blood clot (scab) will have the antibiotics within it.

If you are not allergic to penicillin, then amoxicillin 500 mg is an ideal choice. If you are allergic to penicillin, then clindamycin would be another good choice.amoxicillin

What do you do if you see bone or you are getting small flecks of bone coming out in your mouth? Don’t panic…see your dentist and let them know what you are experiencing. As long as you are not infected then it should not be a problem. If you have an infection of the bone graft and socket then you will likely need to continue antibiotics for a second or third round or sometime switch antibiotic families altogether. I generally prescribe an antibiotic mouth rinse also such as peridex. You will need to have some of the top pieces of bone removed.

Signs of infection would be redness, pus, pain and in some cases fever.

The most crucial thing to ensure your socket bone graft extraction success is that the procedure is done well by someone who specializes in implant dentistry. The correct choice of bone product for your situation is important but not as important as the surgeon and your healing ability.

3d scan burbank ramsey amin (4)

Extraction and bone grafting at the same time is not as simple as just sticking some bone into the socket. The internal cleaning of the socket is super important. All remnants of tooth and inflammatory tissue must be removed. This is not as easy as just scooping it out. The socket must be debrided very well to get down to bare, bleeding bone and is a sensitive procedure especially when you are pulling out a failed root canal tooth.

Fractured root canal teeth are probably the most common extraction that leads to a socket bone graft. Choosing bone that comes from your own body, from a cadaver, from a cow, or totally synthetic all have their pros and cons and you must discuss these with your dentist.

The socket bone grafting for upper front tooth dental implants are critical in establishing the right amount of bone so your front tooth looks great! If there is a dent in the bone, the tooth will look long and may have open black hole triangles near the tooth.

Bottom line…some exposure of bone and bone graft migrating pieces is common, but it is preferred that all of that stays in the socket. It does not mean the graft has failed. Do not confuse a socket graft losing bone with an exposed onlay block bone graft. The rules are different.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry


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303 thoughts on “After Extraction and Bone Graft…The Bone is Showing. Now What? Ramsey Amin, DDS Reviews Options

  1. Amy B

    Hello Dr, thank you so much for the time you spend answering so many patient questions. It’s very kind of you.
    I am having tooth #3 extracted next week (fractured tooth with past root canal). Tooth #4 was removed a few years ago. The dentist recommended a bone graft so that my teeth don’t shift. I will not be able to afford implants in the foreseeable future, certainly not within a year. I have read that there is no point in getting a bone graft if implants will not be placed within a year. Is that true? Should I be fearful of teeth shifting once #3 and #4 are both gone? Again, thank you so much for your input.

    Reply
    1. RamseyAminDDS Post author

      the teeth can definitely move. Doing a bone graft is not likely to prevent movement. If you are planning on waiting a long time to have implants done the bone graft must be done with a material that will dissolve very slowly. Many do not understand that grafting materials heal at different rates depending on what they are made of. If you are going to be waiting a long time and then your graph needs to have a high concentration of A graft material that does not dissolve quickly. There are definitely advantages to ones that dissolve quickly and ones that stay around for a while. Speak to your dentist about this or seek treatment with an expert.

      Reply
  2. Sabrina

    My son had two bone grafts, one each at the sight of his upper incisors, on March 14, 2017 during Spring break from college. I have him back home now with a follow-up appointment Friday of this week with his oral surgeon. I’ve noticed one of his two front teeth has turned light grey. Does this mean the root of his permanent tooth has been traumatized and will it likely continue to darken and dye?

    Reply
    1. RamseyAminDDS Post author

      Hopefully that is not the case. Hopefully it is just some stain from the chlorhexidine, Peridex rinse that he was probably on during the bone graft. If they were changing colors they would also feel different if they were dying.

      Reply
  3. Aaron

    Good afternoon,

    I recently had 3 teeth removed with graft (material), but the one on the lower keeps pushing itself out. My dentist advised me that it was creating a dry-socket underneath and a bad smell radiates from it. The smell and taste is abscess like but he assured me I have no infection. Why does it keep pushing out?

    Please assist,

    Thank you ever so much!

    Reply
    1. RamseyAminDDS Post author

      You may still have an underlying infection. A bad smell is not normal I would take a new x-ray to may do another course of antibiotics. Read this post on membranes and it might help you understand it more.

      Reply
  4. Jenine

    Hello,
    I find this site very informative. Thank you for all you do. I wrote a question a few days ago but can’t seem to find it on here. My son had a bone graft done 10 weeks ago. He is missing a tooth that never came in. For the last couple of weeks he has felt little tiny pieces coming out from the front of his gums. It looks like bone graft material is pushing out a little tiny hole in the front of his gums. The area is a little red. He has no pain and there is no pus or anything like that. I had brought him back to the oral surgeon a couple of weeks ago because that area looked yellowish and I was concerned about infection but that was before was a hole. He said to give it more time and bring him back in June. I plan on calling tomorrow but curious on your thoughts. Is it normal for bone graft material to push through the front of the gums 10 week after surgery?

    Reply
    1. RamseyAminDDS Post author

      Not likely. This is rare. It is usually caused by radiation given for cancer treatment to the face or special intravenous medications given for bone density problems and or cancer chemotherapy.

      Clots sometimes just look a bit dark in the early stages.

      Reply
  5. Angela

    I had an upper molar (#14) extracted and bone graft (cow) after a failed root canal. I am now 10 days post-op and my oral surgeon says it is healing, but my gums still are very sore and tender. Is this normal?

    Reply
  6. Michael Turner

    Thank you for all education you provide, you are an amazing person for taking the time to assuage our fears. My question is about dentures or in my case a partial plate. I have herd that these can affect bone grafts in a negative way, how long should I go without my plate to assure a good bone graft, I am taking some vacation time to stay home while ‘toothless’.

    Reply
    1. RamseyAminDDS Post author

      Thank you for your kind words. Depending on the technique and type of bone graft and removable denture can damage things badly. I’m assuming you are just having basic socket grafting and not more sophisticated grafting like onlay block bone grafting. Make sure that the denture has a soft reline. Maintain a soft diet and keep the dentures out as much as possible. Most bone grafts require 4-6 months to mature. There seems to be in educational gap with many dentists that believe bone grafts can be healed in 2-3 months…. Incorrect!

      Reply
    2. RamseyAminDDS Post author

      Thank you for your kind words. Depending on the technique and type of bone graft and removable denture can damage things badly. I’m assuming you are just having basic socket grafting and not more sophisticated grafting like onlay block bone grafting. Make sure that the denture has a soft reline. Maintain a soft diet and keep the dentures out as much as possible. Most bone grafts require 4-6 months to mature. There seems to be in educational gap with many dentists that believe bone grafts can be healed in 2-3 months…. Incorrect!!

      Reply
  7. Joann

    Hello, I had an extraction and bone graft done about 17 days ago on #19. Had my stitches removed 3 days ago and the surgeon said everything looks good. Is it still normal to feel tightness around the jaw/ gum area and is some swelling in the face normal as well, or could that be an infection? Thanks in advance

    Reply
  8. Sandy Thies

    I have had all of my teeth extracted for dentures and 11 days later I have pain and sensitivity to one place where a molar was pulled and can see the gum does not cover all of the bone. The dentist tells me that this is normal and will heal in time. I am miserable and need to know that what the dentist is telling me is correct. Please tell me your opinion as I am very worried it will continue to be painful and sensitive.

    Reply
    1. RamseyAminDDS Post author

      That can be very normal. I hope by now you’re healing up well and getting past the tough part. Without any implant support the dentures are just rubbing on your gums.

      Reply
  9. gayle

    i had a fistula above the bad root canal… i havr had bone graft plus membrane.. and extration exactly one week ago… 2 days ago i was placed on antibiotic i am in horrible pain. my ear my jaw my tounge hurts…. is this normal?

    Reply
    1. RamseyAminDDS Post author

      Usually the anabiotic start at the time of extraction and not after infection. I hope you’re better now. Not every dentist understands grafting well.

      Reply
  10. Jiwa Farrell

    Hello. Thank you for this informative piece. I am a 39 year old woman with SLE and several overlapping conditions including sjogrens. My parotid gland has recently become involved. Since a crown was placed in the back right of my mouth it has been nothing less than uncomfortable. Now, I have an abscess and am scheduled ( with another dentist) to have an extraction and cadaver bone graft. He hopes to fit me with a partial denture later on down the road as I have a previous extraction on the other side with no graft. I have tried to condense a very long medical hx. I am also on several meds including imuran. Do you think a bone graft is safe for me? I have my doubts.

    Reply
    1. RamseyAminDDS Post author

      If it just hey socket preservation bone graft and will likely heal just fine. This type of bone graft have the same potential for healing as a regular extraction socket and most patients as long as the outer wall of the bone is not missing.

      Some of the bone grafts I do you are massive and I would not perform them on patient who have compromised immune systems, smoke heavily or have certain diseases such as uncontrolled diabetes.

      I treat many patients with immune and metabolic diseases. You just need to have a very prudent practitioner who understands your disease process. Antibiotics are going to be absolutely necessary.

      Reply
      1. Jiwa

        Thank you very much doctor for taking the time to respond. I made the decision to not do the bone graft and am healing pretty well. Thank you for your kindness.

        Reply
  11. Lucy

    Dear Dr Ramsey, thank you so much for taking time to answer all our questions. In October last year I found out I had a cyst due to a bad root canal done many years ago. My 2nd molar was extracted to remove the cyst and I had bone grafting done (cow) for an implant in the future. The problem happen because the stitches came out too soon and my gum didn’t close properly (still hasn’t completely). I had this procedure done in my home country and travelled a week later to another country where I live now. I saw a specialist about a month ago who told me the reason my gum hasn’t closed yet is because there was some bone particles in the way so removed them and told that if they kept coming out it would probably mean the grafting had failed. Nothing had come since but 2 days ago I started feeling a bit of a burning sensation in my gum so I checked my gum and saw that there were some particles glued to my gum again. So my question is: what are the main signs that a bone grafting has failed? Bearing in mind that the cyst was quite big and almost reaching the nerve. The surgery was quite extensive.

    Reply
  12. Alicia Narayan

    I had a bone graft done yesterday and i see the blood clot scab you mention in your article. I’m worried that when I rinse with salt water, the scab might come off and come out. Is that ok?

    Reply
    1. RamseyAminDDS Post author

      Rinsing can cause more bleeding. If you have questions I would suggest you see your dentist for a 2 to 3 day follow-up visit or at least at the one-week mark. Typically a bone graft is rinsed with 0.12% chlorhexidine rather than saltwater. Often oral antibiotics are necessary for bone grafts also.

      Reply
  13. Kimberly Baker

    Hi, my oral surgeon removed an implant that he had inserted 4 months ago but he said it was not fusing to the bone and the area was infected. I have been on antibiotics for 10 days now post removal of implant and the area is still sore and tender and still can only eat soft food. How long before this area were implant was removed will start to feel better, am I looking at another 10 days of clindamycin and is it normal to still feel this much discomfort after 10 days.

    Reply
  14. Judy Webb

    My 40 year old son has SLE. He has had multiple implants with no problem. He grew tired of having them done one at a time, so all of his remaining top teeth were removed and he had a few more implants added with bone grafts and his spun down blood. Six months later he has had many bone spurs. One or two came out on their own, but around 10 or more (I have stopped counting) have had to be removed. The last one with stitches. Now he has another, even larger than the last one. One even dislodged one of the implants, so now he’s back to another few months left before they can put in the permanent top appliance. When will they stop? Is there a way, with maybe a 3-D scan, that will show them so they can all be removed at the same time, under general anesthesia instead of scraping his gums deeper? It is excruciatingly painful for him every time they do this. I think he is a well trained and knowledgeable dentist, but I need to be reassured that my son is getting the correct treatment. Thank you for your insight.

    Reply
    1. RamseyAminDDS Post author

      Was it the same dentist or different dentist that did the original implants? If bone is coming out 6 months later than there is a chance that the bone is not integrating or perhaps some sort of synthetic material was used. Were these basic socket grafts or something more involved like a block bone graft?

      Reply
  15. Pam

    Hi I recently had extraction on tooth number three failed root canal , had bone grafting done . On the lingual side my gum tissue is split up and can see the membrane , will my gum tissue grow down and will it close together or will I need him grafting ?

    Reply
  16. Samantha

    Dear Dr. Thank you for creating this website and the time:
    Which will work better for implant of my two upper front teeth?
    1. Using ‘cadaver bone.’
    2. Using a mixture of ‘Cow bone mix with cadaver bones.’
    3. Using ‘Cow bone’
    Is it true that once the doctor place the bone graft materials, it is better to wait for 8 months compared to 4 months for the bone to fuse?

    Reply
    1. RamseyAminDDS Post author

      Without seeing your having any information I would choose option 2 and I would allow the area to heal for 8 months! Some front teeth require large block bone grafts also.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  17. Samantha

    Dear Dr. Thank you for creating this website and the time:
    Which will work better for implant of my two upper front teeth?
    1. Using ‘cadaver bone.’
    2. Using a mixture of ‘Cow bone mix with cadaver bones.’
    3. Using ‘Cow bone’
    Is it true that once the doctor place the bone graft materials, it is better to wait for 8 months compared to 4 months for the bone to fuse?
    Thanks.

    Reply
    1. RamseyAminDDS Post author

      Without seeing your having any information I would choose option 2 and I would allow the area to heal for 8 months! Some front teeth require large block bone grafts also.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
      1. Samantha

        Hi again,

        Please let me know the benefits (compared to other options) of choose option #2. The doctor I consulted with did not mentioned about large block bone grafts, he just showed me some bone powder. Will it be something similar or equivalence to large block bone grafts? Is it because large block bone grafts cost more?
        I will like to see you in your office.
        Thanks.

        Reply
        1. RamseyAminDDS Post author

          to answer to that detail about your unique specific situation, you would need to be seen. It is not about cost, it is about doing the right thing the first time.

          Reply
        2. RamseyAminDDS Post author

          to answer to that detail about your unique specific situation, you would need to be seen. It is not about cost, it is about doing the right thing the first time..

          Reply
  18. Rosanne

    I had my #10 tooth removed after an x-ray revealed an empty area around my root. The tooth had a root canal years prior. At the time of the root canal, I was told the tooth did not finish fusing in the back so I had a groove running up the root allowing bacteria to travel up, hence the need for the root canal. I’m not sure if that’s why my bone had an empty pocket around the root years later, but I was told I would lose the tooth, so I decided to get an implant. The tooth was removed, a bone and gum graft were done. A year later my implant was put in. It’s been a little over 10 years and about a year ago I had another bone graft because the bone level had receded. This was depressing because it raised my gumline and I lost the triangles of gum next to my teeth. I asked for another gum graft, but was told it would be unlikely to work because of the gum not liking the materials of the implant parts. Both my dentist and periodontist agreed about this. My dentist created a tooth implant that had a gum area on it so that it looks as natural as possible considering the implant is larger than the opposite tooth is. The pink gum area on the implant extends out to look like the gum triangles I am missing. I’m happy with the results considering I did not have many options.

    It has been over a year since I had that second bone graft. I’ve been trying to care for the area well, and as I’d been flossing, I’d noticed a little white dot at my gumline that would come and go. The other day the white dot came out and was actually a piece of bone graft. (I did have a little bit of bone come out when the surgery was done, but a year later, I find this concerning.) I saved the little particle to show my periodontist, who did the surgery. It looks like there might be another piece of bone graft particle showing in the same spot, right at the top of my implant, on the gumline. I’m concerned for two reasons. First, I don’t know if a year out from the bone graft I should be having pieces of bone come out. Second, the last bone graft raised my gumline significantly and I’m concerned about needing another bone graft as a result of losing these particles, and having my gumline go even higher. This is especially concerning considering the location of the implant. What are your thoughts on my predicament? Does bone particle coming out at this stage seem reasonable or expected? Does the gumline raising with each graft have to happen?

    Reply
    1. RamseyAminDDS Post author

      Each subsequent surgery carries risk of the gumline raising up. I expect that your implant never really had enough bone on the outside to begin with. It is super important to have a thick wall of bone on the outside of upper front teeth dental implants. If it is not present it should be grafted in place.

      Some bone grafts that I placed are purposely placed in the composite defect between the bone and the gum. The bone graft actually supports the gum to add some bulk. If that is the case, there is no need to worry if he loses a tiny piece that was only supporting gum. They get trapped in the sulcus between the tooth and gum. I know this is a bit technical but don’t think there is much to worry about. Have a 3-D scan done to make sure that you have enough bone present on the outer wall of the implant.

      In this case you can see how long I took with just a temporary to make sure that the gum line was created the way we wanted rather than just allowing it to fall where it falls

      Reply
  19. Paula

    Hello Dr, thank you for your insight and the time you spend educating the public and easing our minds. I would love to visit you one day for a second opinion if I’m ever traveling. I live in Chicago and am seeing a periodontist and so far the experience is mostly positive. I was recently diagnosed with periodontal disease and my dentist was pretty surprised at the extent of my “damage” due to my young age and educational background. Of course this made me feel very guilty and depressed because while I admit to having neglected my oral health due to not flossing, I’ve always brushed at least twice a day and I also went through extensive orthodontic work in my teenage years.

    Anyway, after going through scaling and root planning, I was left with gaps between my bottom front teeth which was expected because I do have some bone loss. So after going to my cleanings regularly I have noticed a big improvement in my gums and I no longer bleed. However, the worst impacted teeth (bottom two) still are red and that’s because of the bone loss/tissue damage, as explained to me. I know these teeth are sensitive and I try not to chew anything with them because of the fear of them falling out, I have gum recession as well and am doing all I can to salvage my teeth for as long as possible. Anyway my question to you is I noticed I have (for as long as I can remember) a small dent in the middle of my bottom gums, in between my two bottom teeth all the way in the very very bottom of my gums (i would have to pull my bottom lip downwards for anyone to notice. Why is this? Also, do you recommend that I continue going to my quarterly cleanings and doing what I can to salvage my teeth? Curious to see what other insights you have and I know it’s difficult since you dont have my dental records but I just need reassurance that maintenance is key despite the bottom front teeth that have bone loss and red gums. This diagnosis has really taken a toll in my mental well being and it’s sad that someone my age has these problems. Thank you for having this website it really has taught me a lot.

    Reply
    1. RamseyAminDDS Post author

      I can only imagine how this is affected you. That small bump you described is probably normal. Just have your dentist look at it to make sure. You kind of answered your question your self… Maintenance is the key…do what it takes to keep your teeth healthy for as long as possible and should they become unsalvageable then you consider dental implants. You should be having her teeth cleaned every 3 months. Good luck

      Reply
  20. Monica

    I’m English and had all my teeth removed and after I had a lump and was told to massarge the area but 2 months on and it’s at is still there, they did a xray and couldn’t see anything where the lump was now they want to do a gum flap to see what’s going on does this sound right to you? Cause to me if the xray see nothing then what could it be?

    Reply
  21. Lacey

    I had a socket bone graft today and have an MRI tomorrow for my elbow, will I be compromising the healing process with the MRI? Should I try to reschedule?

    Reply
  22. Lea Ann Murphy

    I found this when I was looking up info about “Bone graft on pulled teeth”. I had tooth pain on my top back molar on the right side. This tooth has a crown and root canal done 2 years ago. My Dentist took x-rays and showed me the fracture of the root. Now understand I have a fear of dentist but he is the nicest man who is calm and patient with me and helps me. He told me the tooth needs to come out. He was going to have to cut it in to pieces to get it out. He would then put a bone graft in and set it up for an implant. I must say my heart pounded from fear. If it was just the pulling I think I could take it. He always makes sure as best he can that there is little to no discomfort. But, I read all you need to do to have the bone graft. The scrapping and cleaning. Sounds very painful and hard. Should this be done by a Oral Surgeon? Plus I have issues with a dead person in my body…. Cadaver…I have already explained I can not financially afford implants. Do I need the bone implant. The receptionist said they had to do it because of “not wanting rupturing?” Please help me gather more information so I can make an informed decision.

    Reply
    1. RamseyAminDDS Post author

      there is not a lot of need to do a bone graft if you’re not having a dental implant unless it is the very front and Center upper tooth.

      Reply
  23. Louise Secker

    Hi, I had a bovine material bone graft on my upper right jaw several years ago. My excellent dentist waited many months before fitting 3 implants and another few months before attaching the teeth. They are the 2nd premolar and the 1st and 2nd molars. the wisdom tooth is missing. I had had no trouble whatsoever and have since had a further 5 implants in my lower jaw without bone grafts.
    This summer I started experiencing terrible toothache and pain radiating from the beginning of the implants, all across my cheekbone towards my ear and even down my neck. I have had multiple courses of different antibiotics and also root canal treatment of the 1st premolar. I can feel one tiny sharp piece of bone trying to come through my gum and the whole of the gum area is sore and lumpy. My dentist, who I have absolute faith in, now says that I have temporalmandibular joint dysfunction and I do have terrific pain when he pokes about in the corner of the jaw. This does make sense as I have fibromyalgia however given that my gum is so sore I can’t help wondering if the bone graft is the cause? The pain varies day to day and I take Ibuprofen constantly. It is through the roof today and I am very miserable, hence the message.
    Please can you offer any help? I’m desperate. Many thanks.

    Reply
    1. RamseyAminDDS Post author

      Hmmm…odd. Make sure your bite is PERFECTLY adjusted. This is way more than just feeling that the bite is ok.

      Also try a night guard.

      Reply
      1. Louise Secker

        Many thanks for your comments. I will discuss this with my dentist if the pain continues after my latest problem. Since writing the pain became unbearable and my gums started bleeding which has never happened before. It would appear that I have lost some bone around the end implant and an infection has set up in the pocket below my gum. I am now on a long course of having an antibiotic paste injected into the area and yet another course of oral antibiotics. Given my compromised immune system with other health problems that I have this is definitely not sounding good and I understand that I may have to have the implant removed so I’m feeling particularly upset about the whole thing.
        Thank you for taking the time to reply and very best wishes for Christmas and the New Year.

        Reply
        1. Louise Secker

          Hi, me again.
          Since my last post I have been back to my dentist several times over the Christmas period. Several x-rays showed absolutely no bone loss around the implants as he had originally thought which is great news. He removed the very back crown and post, cleaned the area and put a cap on. He decided that the infection had been caused by the design of the post which was a stock size, the only type available at the time. He is going to make me a bespoke post and new crown to prevent a future occurrence – all free of charge – which is brilliant considering that these implants are 4 or 5 years old.
          I was over the moon and the pain eventuallly subsided and disappeared completely. I had a blissful few days with no pain at all. Now it has returned with a vengeance and I’m at my wit’s end. Once again the whole back gum area where I had the bone graft is sore and painful and my mouth is burning. It is not bleeding though and there’s no pus. The pain is also particularly bad in my cheekbone and radiates around the side to the lower jaw. I am taking Naproxen and Paracetamol and nothing stops the pain. I’m due another appointment tomorrow.
          I know that you suggested a mouth guard but I definitely don’t grind my teeth at all. Is it possible to have an abscess actually within the bone graft or maybe above in the sinus? Are there any medical tests I could have which might point to a possible infection elsewhere?
          Sorry to bombard you with questions again but any insight you might be able to give would be much appreciated.
          Thank you so much and kind regards,
          Louise

          Reply
          1. RamseyAminDDS Post author

            I would surgically flap it open and looked directly. Peri-implantitis if that is the case cannot be 100% diagnosed by regular x-rays or a 3-D scan although both are helpful. Some cases require a exploratory surgery. Something is not right. The bone that it is anchored into could be dead although this is rare it can occur.

          2. Louise Secker

            Hi,
            Thank you so much for your reply. My dentist did exactly as you suggested. He gave me a CT scan which showed an odd cavity behind the larger lump. Today he opened up a large flap in my gum to explore the area. He couldn’t find any signs of infection however he said my own bone had grown over the bone graft covering and there were lots of tiny cavities in the lumps. Apparently it has a very good blood supply which is good. He has ground away all of the lumps back to the original bone graft, smoothed it out and sewn my gum back up. Fingers crossed this will stop the pain. He said that in all his 31 years of dentistry he had never seen this happen before – 5 years after the bone graft.

            He thinks that extreme sensitivity due to my fibromyalgia is obviously a big contributing factor to all the pain that I experienced there. I had to have so many injections before the area was numb enough to work on and I am still shaking, even though there was just the tiniest bit of adrenalin in the anaesthetic.

            So once again, thank you so much for your advice. It is very much appreciated.

            With kindest regards,
            Louise

  24. Jessica

    Just had this done about 6 days ago. Can I smoke again yet? I dont want dry sockets but I feel like its been long enough.

    Reply
  25. fran ingram

    Thank you so much for this article. I had this procedure done and my dentist did not give me any of this information. A particle broke loose the other night and I bled like a hog on slaughter day. I called dentist who dismissed me with “put a tea bag on it” and nothing else. It stopped bleeding after two hours. But the anxiety did not. Today i found a few more bone fragments in my mouth and became frighten…also sad to say…scared to call my dentist for I felt I did not get any compassion needed the other night. So I found your site and all I can do is offer a prayer for you for helping me through this. God bless!

    Reply
    1. Angela Cordi

      I had a molar removed and did not have enough bone to put the pin so my dentist did a bone graft and stitched the opening. I was given antibiotics, pain medication which I did not need to take and a mouth rinse. A week later the stitches were removed and my dentist told me all looked good and in three months he would put in the pin and complete the inplant. It has now been 4 weeks I keep getting food into the opening. My tongue keeps on investigating the area. Is my bone graft going to be compromised? Should I call the dentist?

      Reply
      1. RamseyAminDDS Post author

        Is my bone graft going to be compromised? ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, maybe
        Should I call the dentist?,,,,,,,,,,,,,,,,,,,,,YES!!!!!!!!!!!!!!!!!!!!!

        Reply
  26. Marjorie Andersen

    My daughter got bone grafting after they pull out her wisdom teeth. This was 3 years ago and she is experiencing some very small granulated pieces coming out. Is this normal?

    Reply
  27. Mary

    I had peri implantitis surgery with a bone graft. On October 31. .Stitches came out on tongue side and bone is exposed.., gap in gum , has hardly healed to cover bone, been in pain ever since..now noticed small white pimple looking thing , no pus. Surgeon said everything healing fine..Am I in pain from gum healing ?

    Reply
  28. M.Chan

    Hello there
    I came across this site through my obsessive anxiety ( that leads me to googling) after my dentist told me I would need a front tooth dental implant. I have a terrible phobia of dentists, as well as anxiety disorder and this whole thing has thrown me into a lot of panic and depression.
    My situation is a bit different in the way that I had been in an accident 10 years ago, and hit in the face. It cracked my skull and broke 3 front teeth. They received root canals and veneers.
    About a month ago, I was hit in the face by a baby throwing her head back. It cracked my veneer, and half of it fell off. When I went to get it replaced, the dentist noticed it had damaged too much of the underlying tooth, including a bit in one root. Therefore, he said a new veneer wouldn’t make this tooth functional anymore, and I needed an implant. I currently have a temporary crown on it until I figure out implant consultations.
    What terrifies me is going for so very long with no front tooth. I know they make some hideous “flipper”, but I’m just depressed sick about it. I am now looking around for maxilliofacial surgeons, (though I have an assessment with one directly from my dentist, I have the money to be picky).
    Anyways, my dentist told me I was a candidate (no diabetes, always good health, non-smoker, 38yrs old) and “I had good bone”. I’m not sure if he was lying about that, or trying to make me feel less scared, but if this is the case, will I need a bone graft too? I’ve been reading that in some cases, the surgeon can extract the tooth, and at least place the implant in the existing socket at the same time. In fact, I’ve read this helps prevent bone loss and has had very good outcomes. However, the more I read, the more it seems *every* front tooth extraction needs bone grafting just automatically, which leads to a miserable 4 more months where I won’t even want to go outside lol.
    I realize it’s conditional on my mouth, my health, my bone etc etc. So I guess, my question in the end; is a bone graft mandatory after an extraction of a root canaled, front tooth pre-implant? If so, I’ll just have to accept it. Thank you so much for any help.

    Reply
    1. RamseyAminDDS Post author

      Why not just have an immediate dental implant and same day fixed temp crown??? If the bone is good and you have a skilled provider this should go great!!
      I have done hundreds of these. The bone graft can also be done at the same time and is usually pretty minor.
      In the right hands; this should be way easier than you think. Just find the right DDS! Hopefully one that does both the tooth and the surgery.

      Reply
  29. Michael Turner

    Hello, I have several questions about a molar extraction bone graft. 24 hours after the surgery I found that all bleeding and discomfort was gone, I thought wow this is great, I’m healing fast! Eight hours later I look in the mirror and find that the stitches had come untied (I never felt a pop), and that the membrane was lying there no longer covered by gum. In fact it is just loosely floating there held on by a few loose threads. It is well past office hours and I am about to turn in for the night and not really expecting the membrane to be there in the morning. I believe the membrane is collagen, and the graft is synthetic bone. I am taking 500 MG of amoxicillin three times a day. It would be great to hear back before I can make an appointment in the morning, but it is more likely that this will prove helpful to others who find themselves in this predicament. Should I gently flush with an alcohol based mouth wash (to sterilize my mouth as much as possible), I have an Oral Probiotic ((Steptococcus salvarrius) which is supposed to increase the “good” fauna in the mouth to reduce the bad bacteria), any guesses if this will help? Will I be the one who will have to pay for tomorrows visit or being that the knot of the stitches did not hold fall on the office coffers? My greatest fear of course is that later down the road becomes infected, and worst necrotic bone? Lastly what would your procedure be tomorrow if I were you patient.

    Reply
    1. RamseyAminDDS Post author

      If you were my patient the stitches would not come undone 😉

      I would call your dentist because they are more abreast of your unique situation and circumstances. Obviously it is not supposed to come apart. In the first 24 hours it is possible to replace and re-suture the area. Beyond a few days this is not recommended.

      We typically use an oral rinse called chlorhexidine. No rinsing should happen at all the first night of any bone graft or any extraction. Don’t “flush” anything

      Please update me as to what they did but copy and paste this entire post back into yours so I can follow it more easily. There are a lot of comments that I am involved in around the clock.

      Reply
      1. Michael Turner

        Original Post [Hello, I have several questions about a molar extraction bone graft. 24 hours after the surgery I found that all bleeding and discomfort was gone, I thought wow this is great, I’m healing fast! Eight hours later I look in the mirror and find that the stitches had come untied (I never felt a pop), and that the membrane was lying there no longer covered by gum. In fact it is just loosely floating there held on by a few loose threads. It is well past office hours and I am about to turn in for the night and not really expecting the membrane to be there in the morning. I believe the membrane is collagen, and the graft is synthetic bone. I am taking 500 MG of amoxicillin three times a day. It would be great to hear back before I can make an appointment in the morning, but it is more likely that this will prove helpful to others who find themselves in this predicament. Should I gently flush with an alcohol based mouth wash (to sterilize my mouth as much as possible), I have an Oral Probiotic ((Steptococcus salvarrius) which is supposed to increase the “good” fauna in the mouth to reduce the bad bacteria), any guesses if this will help? Will I be the one who will have to pay for tomorrows visit or being that the knot of the stitches did not hold fall on the office coffers? My greatest fear of course is that later down the road becomes infected, and worst necrotic bone? Lastly what would your procedure be tomorrow if I were you patient.]
        I was told by the Dentist’s assistant that they used dissolving sutures, and that this was expected. I wish this had been explaind to me at the time of the procedure. The assistant inspected the socket and said it was healing nicely. I did have an increase in pain and slightly more swelling 5 days after the original extraction, as it was the weekend I contacted a Doctor who said it was not logical for the swelling and pain to increase this far out, so she prescribed Chlorhexidine rinse and Clindamycin 300mg, the latter of which I do not recommend taking as Nothing left my body in solid form for three weeks.

        Reply
  30. Natasha Gates

    I has a dental implant a year ago. It’s still numb in my jaw bone, I have no feeling along the mandible bone on the left side where the implant is and there’s still a small hole where the graft was placed occasionally I can push on it and a taday bit of pus comes out.

    Reply
  31. Pam H

    Due to extraction if the molar next to lower left wisdom tooth I wore a fixed bridge successfully for several years. Developed and infection in the wisdom tooth and since it was the anchor tooth for the bridge, everything possible was done to save the tooth, including root canal. Ultimately failed, so wisdom tooth removed. Decided to look into implants. Two years ago I found a dentist specializing in implants, and I immediately trusted him. Very thorough, high tech office, felt like I was in good hands. He said I had severe bone loss in that specific area. We did bone graft on both, posts were inserted during the graft procedure, stainless steel (I think) membrane cage around both implants, gum stitched over. Healed very well. Amoxicillin taken after procedure. Membrane removed at week 4, continued to heal. Had consistent pain and swelling, ended up on antibiotics at least four times over the next year. 10 months after graft, implant crowns put in, everything seemed fine. Another infection hit. Clindamycin was prescribed, we figured I might have developed a resistance to penicillin. Infection seemed to finally be eradicated, but an Xray showed a significant amount of bone loss around the implants. Gums had also started to recede only around the implants, especially the interior. I could see and feel the posts. Decision was made to remove the implants, do another bone graft along with with gum grafts, this time not inserting the posts during the procedure. Implants removed, bone drilled out, grafts inserted, my own blood was taken and processed in a centrifuge (don’t remember the technical term, I called it the blood squishy) put into each graft, gum graft from donor Gum, covered with plastic membrane, then gum stitched over. Because of the severe gum recession, I think donor Gum was also used to cover. This was done 9/12/16. I will admit that I smoked the entire two years before this second procedure was done. I had to realize that probably had something to do with the failure. I decided to quit, and my last cigarette was the day before the second procedure.

    Two weeks after this second procedure the stitches opened up while I was on a business trip. I got in the day I returned. He removed all stitches exposing the membrane. Gum just continues to recede. I still had pain and was worried about infection, but Peridex twice a day and gentle cleaning. He removed the membrane one week ago. Exposed white thin gum graft covering the bone graft. He told me to be very careful, it could still dislodge. I have been so careful, barely eaten, don’t touch it with my tongue, nothing. Sonicare toothbrush nowhere near, just up to that area only. The only thing on that space is just Peridex and prayer. Tonight, I took my first look, and I am now terrified. I don’t think the gum graft is there, if it is, it is very thin. And what’s worse, the bone graft that I thought was something I didn’t have to worry about looks like it did before… like it sunk. A good 1/4″ down from the tooth next to it. I see my dentist on 10/19, and due to another business trip can’t go in sooner. I am just defeated. I quit smoking, have done everything right, and now feel a bit of swelling in the vein/gland area under my tongue near the graft site, which makes me fearful of infection. What in the world could be happening?

    Reply
    1. RamseyAminDDS Post author

      Something isn’t right here. It sounds like you’re having everything done by the book. I cannot speak for the experience of the dentist you’re seeing nor the difficulty of your procedure. Those are 2 critical items for the healthy patient!!!

      On the topic of health, depending on your age, you may be undergoing some hormone imbalance, vitamin D/calcium deficiency, undiagnosed diabetes, metabolic diseases of bone, osteopenia, osteoporosis etc. Anytime I have any degree of complications have the patient do a full medical workup with specific bone markers that I order from the physician or have the patient to a blood test in my office.

      I assume you have had a 3-D scan multiple times. There are some areas of the mouth that dental implants do not work well. They are specific within your anatomy if that is the case. I don’t have the exact answers but hopefully these will help steer you in some sort of direction.

      Very respectfully

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
      1. Marlene Trithardt

        I had 2 dental implants removed 6 months ago because of peri implantitis. I have something I can move around, inside my gum that is hard. I have no idea what it is. I was in severe pain for 5 months and the oral surgeon missed that I had a severe sinus infection and won’t address this issue of this hard object in my gums\

        Reply
    2. Peter Marzullo

      Had a bone graft done and it’s now five months and i have sensitivity when I eat on the inside of the gum where the graft was done,
      My doctor said there is no infection however there could be a small pocket he cleaned the molar behind it stating this may be the problem he also mentioned the inside gum wall is thin,He also filed the molar done a bit just a week ago
      Wanted to know if this feeling of rawness which is only when I eat will subside over time or should something else be done
      Thank you in advance

      Reply
      1. RamseyAminDDS Post author

        Hmm. My guess is you have a loose particle of the bone graft somewhere. When the gum gets re-opened to place the implant it should get cleaned out and that little splinter should be removed.

        Reply
  32. Carrie S

    Just described my entire scenario. I just dont see how any oral surgeon could do all of what you described in literally less amount of time than it took me to read the few paragraphs you wrote here. She just extracted the bad root canaled tooth , stuck some gooey whitish what i assume was medicine in the socket and placed the white bone putty in . No stitches nada.

    Reply
  33. Jeff

    Thanks for this forum Dr! I had 13 and 14 removed and a bone graft done, it’s been 9 days since the surgery and all stitches have fallen out. Gums aren’t even close to covering the graft. Noticed today (day 9) lots of particles coming out of area, some hard like tooth chuncks and also soft prices, still 4 days till my first checkup since surgery. Should I try to see the dr sooner? And Joe long does it usually take for the gums to grow over graft site? Thank you for your time.

    Reply
    1. RamseyAminDDS Post author

      This post on membranes should help you understand your particular situation. I hope that helps! Typically I would not use dissolvable stitches for a critical graft.

      Reply
  34. Cynthia ferguson

    OMG,I AM SO WORRIED ABOUT MY DENTURES THAT GO ON BOTTOM I AM DEPRESSED AND IN A LOT OF PAIN I AM 51,,,I AM GOING CRAZY,,,PLEASE HELP !!

    Reply
  35. Steve

    I had a fractured tooth (36) extracted about 10 days ago, and a Bio-Oss graft for future implant. I’m supposed to have the stitches out next week. However, the membrane has resorbed, but the gums have not closed over the socket and the graft is completely exposed. I’m guessing this isn’t normal, and I should go in instead of waiting for my scheduled appointment?

    Reply
    1. diane

      back in may i had all of my teeth extracted due to infection and im only 28!!!! i was told the bone was shaved down but in 5 different spots i have sharp bone sticking through my gums and it is very painful and i dont have the money to have another shave down of the bone what should i do?

      Reply
  36. Carrie S.

    I am just curious to know how many or percentage wise of your patients have ended up with dry socket?
    In my experience i recall when i had all 4 wisdom teeth out a little over 10 years ago the surgeon making a point of saying the dont dos like smoking or drinking with a straw etc because i sure didn’t want to end up with dry socket because its very painful. And pain is the last thing any of us want ever , right ?!
    Anyhow i followed all the don’t dos but i ended up with dry socket in both bottom sockets.
    Here is why though , and i think maybe a lot of people might be like me in not really understanding or getting the concept of what exactly and how blood clotting works.
    I had a tooth extracted last month and this is what i learned finally.
    The biggest mistake i made when i had my wisdom teeth out was how i dealt with the gauze and because there was so much blood and seemed to never stop bleeding i kept changing the gauze which i believed probably removed any blood clot that had formed.
    Also, thanks to the internet a very important tip is to get the new gauze wet first or damp not soaked but just add enough water so its not dry before putting it over the blood clot . This is so important and yet no dentist or oral surgeon ever mentioned it. So i am in case it ever comes up here.
    Dry socket is no joke, although there is a simple fix as soon as one can get back to the dentist office. But what if there is a holiday weekend etc and one cannot. The pain is seriously unbearable.
    Anyhow, basically its really important that a person gets the basic concept of how a blood clot forms and how it works. I know dentists dont have all the time in the world to teach the patient and make sure they understand everything. Thank goodness for the internet!!
    And thank you for being here doc. I really appreciate you!!

    Reply
    1. RamseyAminDDS Post author

      Thanks for your kind words. About 1% get a dry socket. Usually a female too unfortunately. Smoking and birth control pills can increase the risk.

      Reply
  37. Carrie

    Long story short found out 2 root canals failed #31 and #18
    31 crown came loose november 2105 so i pulled it off.
    Had it extracted over a month ago, surgeon did and awesome job.
    Was going to have tooth 18 extracted but changed my mind only to end up deciding on extraction instead of root canal retreatment (insurance wont cover any of that)
    But now there is a new oral surgeon and i was told she wont extract it without me having a bone graft done.
    I cant afford one and im still confused as to why it wouldnt have been an issue before but now suddenly is necessary to do a bone graft.

    Reply
      1. Carrie S.

        Thats what everyone keeps saying. Unfortunately the dental office has me by the wrist right now because its kind of an emergency to me to have this failed root caneled tooth out before the infection does anymore bone damage. And the oral surgeon they have now wont do the extraction without doing a bone graft.
        Her assistant tried to tell me some story about how the roots of the tooth are so long and the infection has done do much damage that something about a hole where the bone is and being so close to a major nerve in my face that i could end up paralyzed on the left side of my face without having a bone graft. Is this possible?
        Or is maybe just an inexperienced surgeon whos afraidy cat who would feel safer doing the extraction with a bone graft?
        I just dont want anymore x rays done. However this office said they would be more than happy to send over my x rays to western dental. Should i just go to them?
        Thanks for your quick response btw

        Reply
        1. RamseyAminDDS Post author

          Without seeing you I can’t provide exact details. You can always remove the tooth without a graft a just deal with it later. Just done wait more than a year. Front teeth are a different story though.

          Reply
  38. Anshu

    Dr amin,
    I had an implant placed with bone graft and resorbable membrane to replace my central incisor. Now it’s been exactly a month and the gums seem to have nicely healed but I can see very tiny pieces of bone sticking out from a couple of places in the gums. There is no swelling/pus/redness/pain. I understand that pieces of bone can come out after grafting but should they be coming out after a month? Could the implant/graft be failing?

    Reply
  39. Brett

    If you could answer my question asao it would be so helpful.

    It’s the long weekend cat get ahold of dentist.

    Had extraction in the top right side at the back , not wisdom teeth all for were out then years ago but I got that big hunk out and my dentist said to not smoke as big roots and I’d be at risk of the dry socket.

    So I didn’t smoke and took care of it o it on day three I snorted and went to spit (without thinking) and out comes this massive blood clot with a bit of blood for the next minute or so.

    I was in shock and I went for s tea bag to try and get it to re clot if I lost it l. What’s weird is I experience more pain but not the type you would expect in a fry socket and while the socket area is lighter like it feels as if it lost its clot the stitches are still on and it’s painful but not as if it was a dry socket. (Since I’ve had one before)

    So finally my question is is it possible to lose some of the blood clot and some of it may still be up there? Or when you lose your blood clot do you lose it all? And any ideas of what I should do I’m putting clove oil around the area for now. Thanks!

    Please help

    Reply
    1. RamseyAminDDS Post author

      Dry sockets don’t happen on upper teeth. Likely you are fine and the clot re-formed.
      Sorry I missed you over Labor Day. How is it now??

      Reply
  40. Oz Hormozdi

    Hi Dr. Ramsy. What would be the best membrane to use in order to cover the bone graft? Is it a good way if you place the suture through membrane and then stitch it to gum? The membrane grafted moves most of the time and bone graft gets exposed and move away from the sockets and we have to redo it again. what is the recommendation please? Thanks for your time

    Reply
  41. kiki

    3 weeks ago I had bone graft , gum is healing well apart from one little tiny piece of bone which i can see ….
    failure of bone graft ??

    Reply
  42. Marcus

    Hello, My two lower right teeth in the back of my mouth both have had root canals. The second to last was done three times. Lack of experience, skill doctor, difficult root canal or all of the above, all I know is I am a working man and that dam tooth cost me a lot of money and know some years later I need an implant. I went to my dentist he took pictures of the tooth and told me I needed an implant. So two days later here we go. The specialist who has done thousands of implants they say, extracted the tooth with some difficulty. There was infection at the bottom and he cleaned it out and filled it with cadaver bone, covered it with membrane and sewed it cup. I am sure there was more to it but I remember I am a Chef not a oral surgeon. They gave me antibiotics, IB profroen and pain killers. I took all of the antibiotics 1 every 6 hours for 7 days. The IB profreon to keep swelling and pain down, The pain killers are useless unless. Most of the pain went away exactly on the seven days just as I finished the antibiotics. I say most because I sill have a very slight bit of throbbing occasionally,(its been 2 weeks know) I take 1 IB Profreon and it goes away. After the seven days was up I was a little worried because I still had a slight pain, a lump on the side of the jaw facing out to my check and it smelled even though I kept it clean and did the salt water
    rinse every couple hours. So I went in on the day the specialist was there and they took and x-ray and the Oral surgeon looked at it. He said it looked like it was healing fine. I was concerned about the lump and he said that he needed to build a good base for the implant in three months so it could support the implant. Ok that made sense to me. So my question to you, is the lump normal with it go away and the slight occasional throbbing is that normal in the first couple of weeks. Thank you

    Reply
    1. RamseyAminDDS Post author

      What you have described is within the realm of normal. I would highly suggest in the future you have difficulty teeth removed using IV sedation and intravenous steroids. You would’ve bounced back in 1 to 2 days with the technique that I use. You can also incorporate platelets from your own blood to accelerate the healing as they contain growth factors which speed up healing and decrease pain and infection.

      Extra bone is better than not enough bone so maybe the lump is a bit extra!

      Reply
  43. kiki

    Dr. Ramsey, i like to thank you for all the articles you wrote about bone graft and implants.
    I got a a lot of amazing Info’s about the procedures ( i am having bone graft done right now and when all goes well some implants on the law jaw
    Thank you so much for taking time to answer all our questions xxx
    Greetings from Cyprus

    Reply
  44. Tina

    Background:
    I had a fistula form on my gum when I was 20 and it was determined that I had traumatized my tooth in the past, it died and there was an infection. I had a root canal done on tooth 24 (USA). 10 years later routine x-rays showed that the tooth canal failed and thus I had an apicoectomy. 10 years later during another routine x-ray there was evidence of bone loss around the tooth so I was sent to a periodontist. The tooth was extracted because the root had fractured. I had a bone graft done at the time but it failed. I had mouth impressions and a CT scan, and I spoke to several dentists and periodontists; all concurred that the best option was to remove all lower incisors, place implants at positions 23 and 26 and create a 4 unit bridge. Surgery was scheduled and the periodontist had hoped to immediately place the implants during extraction but could not because he found that the bone was dead (I think that was what he said, but I was on pain meds for surgery so the conversation is fuzzy). So I had the bone removed, bone grafting (particulates) and a membrane placed over top and removable stiches. I was given pain meds, steroids, antibiotics and chlorohexidine wash. The membrane was in place for 2 weeks, then it and the stitches were removed. During those first two weeks I had very few bone pellets fall out. I have seen my periodontist every week and he feels it is healing “ok”. I am still worried though.

    Questions:
    Is it normal that my gums have still not healed almost 4 weeks after extraction? They still have a white scab, the gums still haven’t smoothed out. There is an actual flap in the back towards my tongue. Every time I talk or use my tongue to push food towards my molars the flap moves creating a gaping area in my gum line. I wake up with at least 4 bone pellets in my mouth every morning; this is much more than I did with the membrane in place. Is it common to still be losing this much of the grafting material? My next visit isn’t until 3 weeks from now. I had hoped to visit family next week (only week that fits into everyone’s schedule), but am hesitant to travel too far away from my periodontist (~9hrs). What is the risk of there being an emergency a month after surgery. Should I cancel the trip? Should I stay close by until the gums heal? How long should this take? I had the impression that my gums would have healed together after a month.

    Reply
    1. RamseyAminDDS Post author

      Keep your trip. You will eventually heal. It will close. You may need secondary grafting at the time of implant placement.
      Good decision to remove all four incisors in most cases.
      Best of luck

      Reply
  45. Tamara

    About a week ago I had an extraction with bone graft on a tooth that was previously root canal treated tooth. I was wondering if it is normal for me to still be experiencing pain in my jaw as well as pain in my ear? Also all of my teeth on the side where the extraction was done hurt very bad and are sensitive as well. I was wondering if this was normal as well.

    Reply
    1. RamseyAminDDS Post author

      The pain is from the extractions and no from the graft. That is the most likely scenario. I’m guessing you didn’t have any intravenous steroids to help you recover faster? If you were sedated by a skilled and caring surgeon this would have likely been done.
      Hang in there. You will get better. 🙂

      Reply
  46. Donna

    I had a root canal/crown in an upper front tooth several years ago. I now have a cyst on the gum above that tooth. I went to see my dentist who said I should go ahead and have a bone graft and dental implant before I have bone loss. Is this accurate? I also know that he uses synthetic materials for the bone graft and said the whole procedure could take up to 9 months. How do I know if I really need this procedure done?

    Reply
  47. Mary

    I had a ramus block bone graft and removal of impacted wisdom tooth 6 weeks ago. I now feel sore throat and have enlarged lymph nodes. I had mono 8 months ago. Could this be dental related?

    Reply
  48. Baba

    Ok, now i have a question
    Will have a removal of 3 “lonely” standing teeth ( not even together ) on my lower Jaw.
    Will get them removed, bone graft on one place and later when all is healed some implants.
    Must say its all in the front
    How long is the average healing time after the extraction and bone graft ( swelling ) since i need a temp. denture to fill the place
    Swelling is my main concern
    Thank you
    Baba

    Reply
      1. Baba

        ” One purpose for leveling bone is to avoid bone grafting. A second purpose would be to provide bone around the entire head platform of the implant. Finally, bone leveling for dental implants ”
        Thank you Dr. Amin….. this is what my Oral Surgeon will do ,,, spoke to him yesterday
        Glad I found this Blog you created xxx

        Reply
  49. Monique

    Hello. My question from yesterday didn’t post for some reason but I had a sinus lift on my right side 6 days ago as well as implants put in (2 there and 4 others on the bottom). I have an appt to see my dentist in a week for a check up and to get the stitches out but since yesterday I can feel one of the the stitches and it seems that it’s coming out, should I call and make an appt sooner or is this okay? Thank you

    Reply
  50. Michele

    I had a bone graft and tooth extraction (back left molar) 11 days ago. I am still in severe pain (Tylenol and Advil every 4-6 hours) and icing constantly. It throbs when I drink water, sore when I talk, and my ear aches like an ear infection. I saw my surgeon yesterday and he said the pain is not normal but may last another 10 days until he removes the stitches. Help! Is this normal?!!

    Reply
    1. RamseyAminDDS Post author

      It is very uncommon unless your bone graft was major and I mean major. Major would be considered a block bone graft. I assume you’re on antibiotics? Please read the post on antibiotics by searching it on the blog. It should help.
      Most of the time the pain comes from the extraction and not from the bone graft.

      Reply
  51. Joanna

    Hi. I had a bone graft five days ago. It’s sore and throbs a bit but not excessively. My problem is I have a terrible taste in my mouth and bad breath. I have googled this which I know is silly but lots of people have reported this is a sign that the graft has failed. Also one of the stitches came out last night. Any advice you could give me would be very much appreciated. Jo from UK

    Reply
    1. RamseyAminDDS Post author

      Hopefully you’re on antibiotics and are using an oral mouth rinse like chlorhexidine. Of course you should see your dentist ASAP.

      Reply
  52. N. Zeise

    I had a bone graft three weeks ago for the second from the back molar on my right side. The gum over the graft was loose at two weeks and now seems to be receding, leaving the graft exposed. Does this mean the graft has failed?

    Reply
  53. Adrienne

    I had a tooth extraction & bone graft this morning. I kept the gauze on as instructed and when I took it off there was no bleeding & everything seemed fine. I have been vigilant with my ice packs & making sure I don’t disturb the area. Have sipped liquids & eaten only applesauce & ice cream. I noticed a short while ago that the site now seems to have an unusual gelatinous swelling on it – I’m scared that despite my efforts the graft material came loose. Am I just paranoid or should I contact my surgeon?

    Reply
    1. RamseyAminDDS Post author

      It probably looks a little bit white and gooey looking which is for the most part normal healing in the mouth in the initial 10 days

      Reply
      1. Eve

        I had tooth #10 extracted 4 days ago with bone graft after and I started noticing the white &gooey part, I’ve had no pain and the little swelling is going away… (On antibiotics) shall I be concerned, shall I let my dr know? Or try to clean it out carefully.. Thank you!!

        Reply
  54. Maria carmichael

    I had a second bone graft after the first one didn’t grow enough bone. Now I have developed a slight temp 4 days after surgery. No other symptoms. Is this normal?

    Reply
  55. Nora

    URGENT – procedure in the morning

    Hello Dr.Amin.
    I am scheduled for an extraction and bone graft tomorrow on #5. It is a dead uncrowned tooth with a prior root canal. It cracked and must be removed. The surgeon recommended that I have an implant but, frankly, I have sticker shock! I think I want to try a removable partial or eventually a bridge because #7 may need a crown anyway. My dentist said she could make a candilever (?) bridge for #5 supporting it with the 2 teeth behind it vs on either side since a bridge including the canine might not look natural. I’m planning to have the bone graft tomorrow just in case I decide to go with the implant sometime in the future or to support the bridge.
    Also, I’m leaving the country for a once in a lifetime vacation in 2 weeks and cannot take the chance of complications. Reading the comments below, now I’m scared to do the bone graft in case of infection or pain on my trip. Help please! Advice? Thank you.

    Reply
    1. RamseyAminDDS Post author

      Sorry…never saw this comment. I got picked up in spam filter.
      What did you decide? How did it go?

      Reply
  56. DeJuan G

    Hello,

    I had an extraction and a bone graft 4 days ago. I’m not having terrible pain, but there is slight pain. Is this normal? I still have my stitches in and there is a light smell. I made the mistake by rinsing the day of my surgery with the medicated mouth rinse that was prescribed to me. I’m wondering was that a huge mistake and causing dry socket? Although I’m not having horrible pain.

    Reply
  57. Sherie

    I had an extraction and bone graft done approx. 4 weeks ago. At my 1 week check up, grafting material was reinserted. I took premeds each time plus 10 days of doxycic following the last. Everything has been fine until now.

    Today my cheek area above the extraction site is constantly hurting. I have been pain free for weeks. Gums are not inflamed, no pus or visual signs of infections. The tooth removed was an upper molar, second to last. The pain is above it and up into my cheek. It is a Saturday so no dentist available until monday. Should I be worried? What should I do?

    Reply
    1. RamseyAminDDS Post author

      This is strange. Typically we don’t add bone one week later. Doxycycline is not the best choice of antibiotic unless you have some strange allergies.

      Reply
  58. Jessica

    Hi Quick Question~ I had a bone graft and extraction last week (7 days ago). Gums are still very sore but one point of the gum is hanging down and almost coming to a point at the one corner. The Dr examined me on tuesday and said everything looks normal but this gum hanging down is umcomfortable. Do you think it will go back in place? Thanks so much in advance!!

    Reply
    1. RamseyAminDDS Post author

      The gums will remodel as the underlying bone remodels. It will likely all just become an oval shape again. Just give it time

      Reply
  59. Suzie

    I had a dental implant placed 3 weeks ago with bone graft on my upper second pre-molar #13. At first, as it was healing there was a white circle (which I assumed might be some bone or gum healing over implant.. But now the white stuff has gone away and there is a dark circle, which I believe is the top/tip of implant.. It is NOT sticking out of gum , it has not pierced through skin. Is this normal healing for dental implant ? What should the gum look like 3 weeks post dental implant with graft? The abutment has not been placed yet; I am still in phase 1

    Reply
      1. RamseyAminDDS Post author

        Your gum tissue and bone are probably very thin and translucent making the implant able to show through. Without seeing you I would not be able to tell you for sure but if this is the case you may want to consider having additional grafting of either gum and/or bone to cover over this area if it lingers around before the tooth is made.

        Reply
  60. Emma

    I had a bone graft done for two missing teeth in my back lower left jaw. Its been a week and a half and I am still in a lot of pain and over the counter pain meds are not controlling it. My surgeon tells me this is normal but everywhere I am reading says the pain should not be that bad after the procedure. Also the gums are still flapped open instead of sealing. Is this normal?

    Reply
  61. Irina

    In preparation for implants:
    I was wondering whether the patient’s own extracted teeth (no infection, freshly extracted or some time ago) can be used as bone allograft, with proper preparation of the material, of course.
    What made me think about this: I saw in some article that a molar with inflammation at the root was extracted, apexes cut and sealed and the tooth inserted back into the socket. In 12 months, bone healed and filled the void at the root apexes, which was evident on the Xray.

    Reply
    1. RamseyAminDDS Post author

      Tooth transplantation or even grinding up natural teeth and placing them back in the socket has been attempted and is not very successful. It is rare for it to work and has an extremely high rate of failure.

      Reply
  62. ritchelle

    Hello Dr. Ramsey,

    I did my bone graph procedure this 30th of March 2016 for this reason. I was diagnosed with
    a cyst (maxillary cyst) found in parts of roots on teeth no. 21,22 and 23. The cyst size was 2.0 x 1.0 cm.
    the cyst defected the bone as suspected by my surgeon so he recommended bone graph. Thank God that I never felt any pain during and after operation with only under 7 days of antibiotic.But, i had a terrible experience with pus coming out of my nose and the granules as well. My tooth (#21) is also a little bit loose/moving.I have no other choice but to suffer the very foul smell all week. My left face swelled. I consulted my surgeon of all my experiences and he said there is nothing to worry about. 2 weeks after, i came back to him as a big bump of pus was at the gum my tooth(#23). So now, i am on 5 days antibiotic to eliminate the infection. So far the bump shrinks down but not yet completely.
    Is there really nothing to worry about with the granules that came out of my nose, the infection and my tooth moving? Will the insurance cover this kind of procedure given the very reason of it? thank you so much for your thoughts.

    Reply
    1. RamseyAminDDS Post author

      I hope by this point you have improved tremendously. Often times the process should be cultured and two antibiotics given simultaneously to treat a severe infection. This does not happen commonly.

      Reply
  63. Parker

    Hello Dr. Ramsey,
    I was wondering if a tooth bone graft is needed if you do not want an implant. I had tooth #2 extracted about a week ago and ended up with a bone graft that I supposedly needed. The bone graft was not explained properly to me and honestly after reading your article I feel like an idiot for not questioning the procedure further. I was told that the bone graft was needed so the sinuses would not slip through. If this is something that is needed why isn’t it covered by insurance?? I did not get it for cosmetic purposes. Thank you…

    Reply
    1. RamseyAminDDS Post author

      If you’re not having a dental implant for tooth #2 ( American dental numbering system for the upper right second molar) there is typically no reason for bone graft. This sinus wont come through.

      Tooth #2 in the European/international numbering is an upper front tooth which I would highly suggest a socket bone graft because it is a highly aesthetic area.

      sorry ;-(

      Reply
  64. carrie

    Hi i had a extraction on my tooth next to the wisdom on the bottom. He had a very hard time getting it out, and said i should have gone to a segant. After getting it out 2 days latter got a dry socket and the bone on the inside of the gum was exposed, he has numbed it morning and night for 10 days with no releaf and more bone is showing is this normal. The pain is real.

    Reply
    1. RamseyAminDDS Post author

      A dry socket is usually treated by placing a medicated packing into the socket every 2-3 days. Just numbing it isn’t going to help.

      Reply
  65. Dee

    I had two extractions with bone grafting on my wisdom tooth and molar lower left jaw. Is it common for there to be tooth pain in surrounding teeth after this procedure.

    Reply
  66. Susan

    How important is amoxicillin after bone graph and implant?
    I am feeling flu like symptoms on this and don’t want to take it.
    My eyes actually hurt when I move them.

    Reply
  67. Lauren Smith

    I had an extraction with bovine graft about 10 days ago. Today I took a video of that area and am shocked to see absolutely no gum at all over the socket. I had a small piece of dead gum come out of my mouth a few days ago; was this a failed gum flap? How worried should I be? Shouldn’t there be gum there?? I’ve been eating and am terrified I’ve lost the graft or might get an infection! My follow up appointment is not for another 5 days.

    Reply
    1. RamseyAminDDS Post author

      Why not just move up your follow-up visit and be seen by the dentist earlier than scheduled? That is what I would do for my own patient that was afraid something was wrong.

      Reply
  68. Patricia norris

    I had bone graft and implants set 16 years ago since than I have lost bone and also bone around one of my implants can I get another bone graft on my jaw bone and around my implants

    Reply
    1. RamseyAminDDS Post author

      Yes it is possible to have a bone graft around an implant that is losing bone. Checked out these articles that I wrote on the topic of peri-implantitis.

      Article 1

      Article 2

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  69. Kristen

    I had my two front teeth extracted on Tuesday. Dr. did a bone graft on both. I have noticed stitches hanging down and being annoying. Also whatever whit squishy thing was between my gums n stitches was hanging down very low when i woke up this morning. Today is Thursday, I was rinsing with salt water as I noticed the stitches n white squishy thing are hang down coming out of my mouth. It came out. Called my dentist, worried!!! Receptionist said don’t worry about it, we will see you tmw at your appt. Should I be worried?

    Reply
  70. Tanja Rivera

    Hi,
    I had a bone graft done in place of where a bottom molar was extracted. It has been 3 weeks and the gums are not covering any portion of the top of the membrane that was placed in there. Is this normal? It just looks very gaping. I also feel as though the inner side of my gums are receding down further and further when shouldn’t they be healing together to reform my gums? Thank you for your time

    Reply
      1. nico

        I had an extract about 2 months and still not healing got a big bone out but there’s more in there who should I contact now both dentist and surgeon don’t know about this

        Reply
          1. nico

            Like ? I had a big bone piece come out the other night inch or two want me to email you the pictures I toke or contact me at [email protected] and ill inform you more I going thur alot of pain right now

  71. Karen

    I had a extraction and bone graft 5 weeks ago on a lower molar. I see a lot of bone coming through and can’t find anywhere if this is normal healing? Also the tooth directly behind it is very sensitive now and I can’t even bite down without pain. Also cold and hot is an issue with that tooth.
    Thank you

    Reply
  72. Miriyam Gevirtz

    My dentist planned a synthetic bone graft without telling me any reason and charged exorbantly for it; denied me pain relieving clove paste for two weeks making me suffer excruciating pain and limiting my life (I took Ibuprofen and Clindamyacin even though there was no infection ever before, during or since). The dentist finally allowed A $200 treatment of clove paste and made be pineapple core and juice as a natural anti-inflammatory but are currently blackmailing me saying I was refusing care when i didn’t and that I had an abscess which I didn’t and should see an oral surgeon which they refused to name in order to deny the clove paste.

    My question is that the graft appears to be inflaming the nerve it is resting on and causing the month of pain which was diminishing with the clove paste they are now trying to blackmail me to sign to cover their pain causing deeds; and, especially the anti-inflammatory pineapple the dentist made for me. What could be causing the extreme nerve pain? They already have adjusted the truth in a today’s accounting. SCAN’s DeltaCare doesn’t cover bone grafts or oral surgeons as far as I can see.

    Reply
      1. Miriyam

        What’s wrong with clove paste? It was the only palliative that helped the excruciating pain and is sometimes, I’ve read, packed into the excision site. It is used on baby’s who are teething I learned. The United States of America with its home grown dentist cheaters.

        Reply
        1. RamseyAminDDS Post author

          Your negative comments are not appreciated. I am simply trying to help you during my free time. Pastes and gels that contain eugenol are often used to treat dry sockets but are not used to treat implants and bone graft pain.

          Reply
  73. Andy Stocker

    Hi Dr,

    I had an extraction and bone graft done on tooth #10 2 months ago and everything is healing fine. Due to working out of town for 6 months, I was wondering if a Sept-Jan implant (9-12 months after graft) is too long and/or extremely uncommon? I have a flipper and it doesn’t bother me at all. Was going to ask my perio Doc when I go next month but found this article and thought I’d ask you first.

    Reply
    1. Andy Stocker

      I am 40 yr old male, 20 year old trauma on that tooth…otherwise good gums, doc said it was “healing better than it should”

      Reply
    2. RamseyAminDDS Post author

      This should be fine. Allowing the graft to mature more is often helpful. Too often people try to go too fast!

      Reply
  74. Nane

    Hi Doctor Amin,
    My molar tooth, located in the left bottom part of my mouth, already root canaled and with a crown, had an infection underneath. On Monday I had the tooth extracted but during extraction the root broke so my dentist did bone graft with a couple of stitches. It’s been 2 days and my cheek is very swollen. On top of the stitches there is a yellow mucus collection and there is still pain. Do you think it is infected? Is it normal for mucus to collect on the wound?
    Thank you.

    Reply
    1. RamseyAminDDS Post author

      It is probably OK. Make sure you see a dentist for an immediate follow up to check it rather than waiting and being concerned.

      Reply
  75. Atul chadha

    I had implant on upper 11 and 12 teeth with bone grafting but after the surgery the labial tissue bulk is more apparent on the 11-12 site as compared to 21-22 site does this happen after the bone grafting? J

    Reply
    1. RamseyAminDDS Post author

      That is a good thing. Always better to have more because it will likely shrink a bit as it continues to heal.

      Reply
  76. Stephanie

    I have my front tooth pulled out long time ago, my gums have shrinked and a significant bone loss, i did bone graft / bone augmentation today but my dentist said she prefer that i do block graft, but it is too late now i think as i already have the surgery. She said we wait for at least 7 months and she will check again if the bone on top of the screw she place will osseointegrate. Is this procedure correct? Please help.

    Reply
    1. RamseyAminDDS Post author

      It sounds like you had a tenting screw or screws placed. Wait at least 6 months then reevaluate.

      Block grafts are often the best. Not too many dentists do them because they are hard to do. Search my site for block grafts to learn more.

      Reply
  77. Shelly Rigg

    Hi Doctor Amin
    I had bone graft for eye tooth that has been missing for 25 yrs because I have a large indentation in gum that makes tooth on bridge look black on top. My dentist sent me to a periodontist for the procedure. I’m a bit upset now that my dentist didn’t refer me to an oral surgeon so I could’ve been sedated because the procedure was difficult to be awake for. It’s been 6 days and the pain is an 8-9 on scale of 1-10, is this normal? I called doctor’s office and they told me to put warm compress on it. I’m allergic to pencillian so I was taking a Zpac. The pain comes and goes in waves. 🙁 It hurts all the way into my left ear. I’m missing work and life due to the pain. Wished I never would’ve had this done. Btw I have a fairly deep pain threshold. Had a C-Sec on a Friday and when I left hospital I went to work (on that Monday).
    I’m extremely grateful for any advise you have. Thank You!

    Reply
  78. Linda Hutchison

    I have an infection after bone graph for implants. After antibiotics it still shows little pockets of purplish flesh. Will see dentist in a month. How dangerous is this infection and should I wait a month? Worried silly. My dentist is overseas, can’t afford implants here.

    Reply
    1. RamseyAminDDS Post author

      You should be seeing a dentist about every 5 to 7 days until the infection has cleared. Infection can cause all the implants in bone grafts to fail. Unfortunately I have heard this situation commonly were someone seeks treatment out of the country and has no one to turn to when they return to the United States. If I were you, I would see a dentist here in the United States ASAP. Antibiotics do not treat all infections.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  79. Edel

    Hi doctor.
    I had a bone graft 3 months ago. It got infected but then I took antibiotics and they said it was fine and didn’t need to have anything done to it. Now some of the granules are poking out through my gum. Is that normal?

    Reply
    1. RamseyAminDDS Post author

      Sometimes. Give it more time. Those granules will likely be removed at the time the implants placed. If it was a socket graft you probably don’t need to worry.

      Reply
  80. kevin

    Just had all teeth pulled its been 10 weeks done impressions even tried dentures fit perfectly he trimmed bottom gums now bone showing on both sides at, back will he have to remove exposed bone? A little scared about this situation

    Reply
    1. RamseyAminDDS Post author

      I am guessing this is on the inside of your bottom jaw towards the back. It may take 2 to 3 visits to resolve this but it should heal after that. Reduce your smoking or eliminated if you do smoke.

      This is called the mylohyoid ridge. it is a sharp projection that sometimes becomes exposed when extracting lower molars.

      Reply
  81. kevin langlois

    Hey doc just wondering I recently had all teeth removed for dentures he trimmed bottom inside gums so dentures would fit now where he trimmed gum bone is showing I am a little scared now dentures will be here Monday will he have to trim more of the bone so it will heal properly?

    Reply
  82. Macy

    Hello doctor,

    I’ve had 3 missing lower right molars for about 10 years now. I went to a dentist and she told me that she would be able to perform an implant procedure and a bone graph will not be required. I do notice that I have a pocket and have lost some bone in that area, but she assured me I’ll be fine. My question to you is, if I was to go through with the procedure, what could possibly happen if there isn’t in fact enough bone. I’m having anxiety and can’t sleep at night.

    Thank you in advance

    Reply
    1. RamseyAminDDS Post author

      Depending on the area, bone grafts are not always necessary. The final teeth may look different at the gumline because the original volume of bone is absent. This is generally OK for the lower molar area

      I would highly suggest that a 3-D scan was done prior to implant placement.

      If there is an enough bone, the implants will either fail in the short-term or in the long term. Having enough bone for implants is an absolute requirement

      Reply
  83. Caroline

    I had a free flap done to my foot, about 9 weeks ago now, I got an bacteria infection, I’ve been taking two lots of antibiotics and I’m starting to loose Ouse from around my wond is this normal

    Reply
  84. Naomi

    Hi Doctor, I was due for a root canal on tooth #19 lower left, as my doctor was attempting to do it he realized that I had too much decay and could not do it. So he sent me to a specialist who needs to extract the tooth (surgically) and put a bone replacement graft (ridge I think) my question is; do I need to go on with the implant ($1700) then the crown ($1300) which by the way i simply cannot afford (in a young adult working, school) or can I stay with the bone replacement indefinitely? And What causes will that do if any? And can I just pull out the tooth without putting the bone graft or do I have to?
    Ps: the tooth around #19 are fine and I am 25 years old.

    Reply
    1. RamseyAminDDS Post author

      all of the teeth in that area will eventually collapse without replacing the tooth. Graft will only hold the bone for a few years but that will eventually shrink too

      Reply
  85. Monique

    Hey Dr.!
    I just had a tooth extraction from where I had a crown and root canal. They put a bone graft where they extracted the tooth. As I was flossing my teeth I noticed that the bone graft looked like it was bulging out of the side of where he put the stitches. Is that normal? Or should I contact my dentist to fix it?

    Reply
    1. RamseyAminDDS Post author

      Better to have more than less bone!! Sometimes that is normal and is usually a GOOD thing!!!
      🙂

      Reply
  86. ray baker

    Hi Doctor,
    I had the top right number 2 tooth extracted about 10 days ago. The doctor used bone from a cow, and then placed a membrane and stitched it. A few days later, the gums around it entirely collapsed, and I felt a significant amount of the bone granules falling out. My dentist has seen it, and told me that I have to wait and see what happens. I’m concerned and want to know what the risks are. I’m still on antibiotics, and am not in pain.
    Thanks

    Reply
    1. RamseyAminDDS Post author

      Hopefully it was over grafted and you have a bunch extra. You may need a sinus lift for this area if it is the American tooth number 2.

      Reply
  87. Andy Wong

    Hello Dr. Is it uncommon to put bone graft in an infected extraction area? My doc said the blood flow and antibiotics will help so no need to worry. Implant to be done 4 months later.

    Thank you.

    A

    Reply
  88. J.Lynn

    Hello Dr.,

    I am scheduled to get an extraction of my left lower molar due to bone loss. My wisdom teeth were removed many years ago. I am very comfortable with this decision . My concern is this may alter the structure of my face. Is there a possibility this may occur.

    Please note.. all of my other teeth have pockets from 1 to 3, but this teeth is stubborn, and there is bone loss.

    Also, I have never had a root canal, just filings.

    Thank you for your response.

    Reply
    1. RamseyAminDDS Post author

      It is very unlikely to occur especially that you have almost all of your other teeth still. Replace the area with an implant and it will be fine. ?

      Reply
  89. zahida

    Hi doctor
    i needed some information please,i recently had my top last tooth extracted and when it come out i was shocked to see that a piece of bone came out stuck to the end of the root.my dentist assured me it was ok i needed some stiches and was sent home only to come back the following day with dry socket.i was given antibiotics and mouth wash…..
    i am still in pain and swollen should i be worried ,is the bone loss serious,i am 34 years old.

    Reply
    1. RamseyAminDDS Post author

      Dry sockets don’t happen in one day and they don’t happen on the upper jaw.

      The bone that was lost isn’t that critical. It can happen as a complication but likely won’t cause you any long term problem.

      I am guessing this was a tooth that had a root canal and crown or just a really bad cavity.

      Reply
  90. Lisa

    Hello Sir,

    I had a graft completed 5 days ago. I was on penicillin prior and it ends tomorrow. I am also using the mouth wash. Is it normal to still be in pain? Neither Advil or Tylenol help. Should I see my family doctor? Being thr weekend I’m not sure if I’ll be able to reach my dentist.

    Thank you,
    Lisa

    Reply
    1. RamseyAminDDS Post author

      This is not uncommon. If the pain is worsening call your dentist. They should have an emergency number. Your doctor won’t know what to do since they don’t do this.
      It also depends on what type of graft you had. Some of the grafts that I do are massive involving 14 teeth at the same time while some are quite tiny.
      My guess is that this is normal. If you didn’t have IV sedation you likely didn’t get the benefit of an IV steroid that helps with pain afterwards.
      I hope this helps.
      😉

      Reply
  91. Kim

    Happy New Year ………
    I have extracted teeth and implant done on tooth number 15 on Dec 24. I saw white patch on the gum look like cold sore today . Is it infections
    Thank you

    Reply
    1. RamseyAminDDS Post author

      Not all white spots are infections. White is a normal healing color. See your dentist for a follow up check.

      Reply
  92. Dan

    Hello Sir,
    About three weeks ago I had a block bone surgery where they grafted a block of bone from my chin and placed it in my upper front gums in order to be able to place three implants. I am 30 years old now and when I was 14 I knocked out my frnt upper teeth my falling of the bicycle. I had a long bridge from canine to canine and now decided to get implants.
    The bone graft surgery went well and I am now wearing a flipper when at work. I noticed in a previous comment you stated the pink part of the flipper can be removed. Now that the gum has healed and is coming further down more I feel discomfort as it’s pressing on the flipper, should I have it adjusted? My surgeon said it is normal and I can continue wearing it so that the gums can mold around it. Also, I feel that after I use the electric toothbrush versus a regular, the area is a little swollen. Are electric toothbrushes ok to use after a block bone graft? Thank you.

    Reply
  93. Mr.Tom

    Dear Dr…. Sir…
    I really would appreciate your opinion, as it would be the greatest gift that could be given to me this at this point during the holiday season that we are in.
    I am sorry that this is so long, but my pain is “wicked”.
    I had all my teeth extracted out of my bottom jaw, it’s been a week.. and immediate dentures were put in. I was told to keep the dentures in 4 days, then I could remove them at night and start rinsing with slight warm water. The sockets have no sutures, only medicine was packed into each socket. Where the bottom canine teeth were, right under the sockets I noticed that there is in the front that the tissue is gone, and there is exposed bone on both the left and right side of my jaw. I believe that the bone is part of the canine socket itself.
    I am going in monday to get the dentures adjusted but what other things can be done because the pain is extreme. I have been using orabase numbing paste and gel form, and that helps with the pain around were the bone is showing. I have been trying to reduce the pain medicine that I am on as well, and the sockets do not hurt and look like they are healing, but these bone that is shown does not seem to be healing. I remember something like this happened to my upper jaw when my dentures rubbed off the tissue and I had the same spots, and another dentist had me use peridex prescription mouthwash to heal those exposed areas, I think you also recommend this peridex. Would this mouthwash have any negative affects of healing the top of the sockets? I’m trying to reduce and stop the pain medicine that I am on, because I need to go back to work.. but because of the pain from the exposed bone, I am finding it “very” difficult not to take the pain medicine. I also have penicillin that I am going to star taking. I was on other antibiotics when I had the procedure done and I have finished those, but I also have a full bottle of penicillin that my dentist said that I did not have to take. I think because of the bone being exposed, it would be a preventive. Any help that you can suggest in regards to the expose bone, I would greatly appreciate. Thank You Dr. Sir.

    Reply
    1. RamseyAminDDS Post author

      Merry Christmas

      I hope you are doing better five days later after this post. Exposed bone after immediate dentures can be common. The best thing to do for is to adjust the dentures so it no longer rubs in that area and do not wear the dentures. antibiotics are typically helpful if there was a lot of teeth extracted, bone removal, large flaps and or medical issues such as smoking and diabetes.

      Mouthwash is minimal useful but it can help. Adjusting the dentures and possibly placing a soft reline inside is best.

      Often times the exposed bone needs to be removed. This is generally very easy to do and a relatively painless because the bone that is exposed is dead and really doesn’t have any nerves. We call that a debridement.

      Good luck and let me know how things are going.

      Ramsey Amin DDS

      Reply
      1. Mr.Tom

        Dear Dr…. Sir…

        Thank You for your reply. You are 100% on correct with your assessment. The part of the denture was rubbing off any new tissue in the front lower jaw right were the canine socket are and below, after the local office made the internal adjustment I noticed that I had hardly no pain. There is already new tissue forming there, so probably about another week and both of those jaw bone areas should be healed up. Also, I am not trying to chew hard, but in fact I have eaten solid food in the past 3 days, so that is really great progress. The peridex mouthwash, seems to be also helping.

        You also answered another thing that I have been thinking about. I do feel two places where there is bone directly on the top of the lower jaw, where two socket are. They are not bothering the denture or me per se, but I’ll ask the local office where I go to, if debridement may be needed. Thank You so much for your professional courtesy, in answering my question.. I was in a lot of pain at the time.

        You are a man with great ethics and integrity for answering my questions. I’ll will certainly pass to any of my stakeholders in California that is looking dental work that fits your specialty, that I personally recommend you.

        Thank You again, and I hope you have a great upcoming new year!
        Mr.Tom

        Reply
  94. Denise Howard

    I had a bone graft/implant on Dec 11 on my right eye tooth. Was a failed root canal crowned tooth. I have a “flipper” that my general dentist adjusted immediately after my surgery. By Monday Dec 13 I noticed a ulceration at gum site so I went back to general dentist & he adjusted it again. After wearing it to work last night I noticed this morning that my gum was more swollen & ulcerated. I am on clindimycin & peridex mouthwash which I have used as directed. I am afraid that I may have had pressure on the surgical site & my bone graft may fail due to this. I’m off to the oral surgeon who did the implant in the morning. Any ideas I would appreciate. Thanks.

    Reply
    1. RamseyAminDDS Post author

      Just make sure that the flipper does not touch the bone graft area when you bite. The flipper will bend slightly so it needs to be relieved on the inside so that no pressure is applied to the graft. I’m sure your surgeon or dentist will be able to do this. Typically the pink part of the denture is removed since you hopefully don’t need it anymore after the graft. Don’t want the pink part today into the gum on the outside.
      Respectfully,

      Ramsey Amin DDS

      Reply
  95. Sheena Johnson

    I had bone graph surgery 2months ago. I dont have any discomfort at all. My comcern is the puffyness/slight swelling under my eye close to my nose cheek area. Could this be permanent swelling??

    Reply
    1. RamseyAminDDS Post author

      Very unlikely.

      I would make sure it is not coming from another tooth or not even related to your teeth at all. Swellings of the face are not normal 2 months after procedure.

      What kind of bone graft techniquedid you have? Be sure to re-reference your original questions so I know the context.

      Reply
  96. Payton

    My husband had a tooth extraction with grafting done on his right upper molar. There is an odor he has coming from that area but no signs of infection. He’s on antibiotics. Is this smell normal?

    Reply
  97. Dave Johnson

    Greetings Dr. Amin – last December, 2014 I had a few lower, right teeth (believe were #’s 27 and 28) extracted due to external tooth resorption. In approximately May of this year, I had a bone augmentation procedure done in that area due to the amount of bone loss. I’m now getting closer to implant procedure, to replace both teeth. I’ve had some comments over the last few months about halitosis from friends. I get my teeth cleaned 3X year at dentist, and have taken great pride in oral hygiene. My question is whether the artificial cadaver bone (used as artificial bone) can be causing this? Or is that even possible? How could I tell and if it is possible how would/could it be treated? Thanks Dr.! Dave

    Reply
    1. RamseyAminDDS Post author

      I would make an appointment with a dental hygienist. Spend the entire 45 minutes to an hour with the hygienist showing you proper oral hygiene technique. I know it sounds silly, but probably 70% of people say they brush and floss do it incorrectly.

      This would be worth spending $100 on. It is not the cleanings that matter. It is what you do at home matters the most. An electrical toothbrush with a soft head should be used for 3-5 minutes at least twice a day. 2 minutes is not enough. Also brush your tongue.
      There is only one right way to do this. Of course if there is any underlying problem such as periodontitis on any other teeth that needs to be managed.

      Sometimes halitosis can be caused from the base of the tongue can be treated with chlorhexidine or believe it or not… dilute bleach!! Make an appointment with a very contemporary hygienist. This is not from your bone graft if it is not exposed.

      Ramsey Amin DDS

      Reply
  98. lakeisha

    good morning Dr. I am A 42 year old female who’s had on the 28th of October my wisdom tooth that was completely rotten and a back bottom tooth extracted I also had bone grafts since then I have lost so much weight and the lymph nodes on the side of my neck have been swollen I still taste blood in my mouth from from the gum diseaseI have appointment next week for deep cleaning how severe is it once you get your teeth extracted and you go off of antibiotics that the poison is still going through your system..

    Reply
    1. RamseyAminDDS Post author

      I don’t understand your question fully but it is always better if possible to have had deep cleaning prior to removal of the wisdom teeth. This decreases the amount of bacteria your mouth in general. It is very extremely rare that I would do a bone graft and a wisdom tooth socket. These tend to heal extremely slowly and have very minimal benefit if any at all

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  99. Jeff

    Hello Doctor,

    Thank you for writing informative blog posts, and answering a list of questions from nervous patients like myself.

    7 days ago I had my #18 Molar extracted and socket bone graft. It was a failed root canal tooth. Pretty standard stuff. Yesterday I noticed that the sutures began to come loose and lift away from the extraction site. Underneath the sutures is a white substance that is also lifting from the socket a tiny bit, and I am concerned that my bone graft is failing. I am a smoker, although since the extraction I have quit and kept my mouth as clean as possible.

    It is a chance that I am losing the graft? Or is this just a membrane and nothing to worry about? I have no pain, swelling, pus, or fever, just the annoyance of loose sutures and the worry of the white substance.

    Thanks!

    Reply
    1. RamseyAminDDS Post author

      At this point it is too early to tell. There are so many different variations of this procedure and an amazingly wide range of experience. Some dentists will go through extreme detail and use very high and products and membranes while others will unfortunately use what is on sale or have no rationale for their choice of graft, membrane, or sutures. I train a wide variety of dentists from expert level to first timers so I have seen at all.

      I would go ahead and move up your follow-up appointment and be looked at sooner rather than later. I’m assuming you are on some type of antibiotic such as amoxicillin or clindamycin hopefully.

      Keep me posted and please reference you’re original post by copy and paste in the entire text.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
    1. RamseyAminDDS Post author

      Was that the intention of your dentist? Sometimes I place membranes that I want and need to remove while other times I needed to stay there for 4-6 months. Look at this post on membranes that may help you understand the process and of course speak to your dental implant surgeon.

      Happy Thanksgiving

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  100. Cristian

    Hello:

    I had an extraction implant and bone graft done in the upper jaw first molar. After two weeks of pain slow healing and feeling of pressure in the implant area I requested the surgeon to take it out today. She did althought her advise was to wait for more time which I did not want to. I had a few extraction 2 implants before and it was resolved quick with no pain afterward. What was different this time: bone grafting and doing the implant just after surgery, two thing I will never do again. We decided it was best to put the implant out and also the bone graft and leave to heal it naturally. Do you think this pain and pressure came from the implant or the bone graft? When she removed the implant there was no sign of infection and the implant was strong (not loose).

    Reply
    1. RamseyAminDDS Post author

      Hello Christian

      The pain likely came from the implant and not from the bone graft. The fact that they were done at the same time is of no significance. Rarely, an implant can place pressure on a natural portion of your bone that fused together at the time of your jaw formation. We call these “suture lines” in the bone. This can cause it to feel like it is expanding your jawbone similar to somebody going through braces. Removal was a good choice. Wait for to heal up for a while and then go ahead and do it again a few months later. You should not have too much problems a second time around. Good luck.

      happy Thanksgiving and thank you for your question.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  101. Michelle Nguyen

    Hello dr,I have my second bonegraft done for my front teeth on 11/6/15 for 4 front teeth implant the 1st one on 4/17/15 due to not enough bone intergrated he went in filled in 2 mm cadaver bone and take out the 2 screw !!is been 10days I notice there is a black hole between from my 3rd teeth to my two center teeth to my left is that normal dr should I raise a concern!!whats should I do !!my gum wasn’t like that from the beginning!
    Please advise thanks dr.Ramsey

    Reply
    1. RamseyAminDDS Post author

      Ugh. It sounds like things arent going well. Hang in there. Sometimes a secondary graft can correct everything but of course I don’t know your particular situation.

      I tend to always graft 10 to 20% more than needed just in case anything shrinks to prevent the need for a second bone graft

      Reply
  102. michelle

    I had my bone transplant done 5 days ago and You said the gum will cover the exposed bone transplant. I feel the gums starting to cover it but what if food gets trapped in the area before it closes and it encloses food and locks it under the gum? Won’t that cause an infection?

    Reply
    1. RamseyAminDDS Post author

      no….just give it time. It really depends on the technique in type of membrane that was used also. I would assume that you’re placed on antibiotics for the first week and used a mouth rinse such as chlorhexidine for about 10 days. That will help prevent infection.

      Ramsey Amin DDS

      Reply
  103. Kelly

    Sorry I should have been more specific, it was a simple socket bone graft. I was on antibiotics a week before and after the extractions as well as a prescription mouthwash. I really feel fine just wanting to make sure what I’m experiencing is to be expected, I know everyone heals differently so I am hoping I’m on the right track.
    Thanks.

    Reply
  104. Kelly

    Hello, I had a bone graft done in my bottom left jaw where my dentist extracted an old root canal. My question is that it is now 3 weeks later and the stitches were removed 3 days ago and I can see bone particles and every so often one comes lose into my mouth, no pain, no infection, good color, just a nervous patient. Is this “normal” during the healing process?

    Reply
    1. RamseyAminDDS Post author

      Don’t panic…see your dentist and let them know what you are experiencing. As long as you are not infected then it should not be a problem. If you have an infection of the bone graft and socket then you will likely need to continue antibiotics for a second or third round or sometime switch antibiotic families altogether. I generally prescribe an antibiotic mouth rinse also such as peridex.

      I am assuming this is a basic socket bone graft and not an advanced type of graft.

      Reply
  105. Shauntae

    Hi, when I was 14 I had implants on my top front teeth. 20 years later, the dentist pulled them out. Not because I had and problems with them. It was the rest of my top teeth that needed to come out. For the last 2 and a half months I’ve had constant infection, pain, swelling. I don’t think it’s healing at all. It hurts too much to continue with getting new teeth. I had all 4 wisdom teeth cut out and never had any problem.What are your thoughts?
    Thank you

    Reply
    1. RamseyAminDDS Post author

      It sounds like you have a severe case of periodontal gum disease that needs to get under control. This will eventually cause the two implants to fail also.

      Were you not aware of the gum problem? It usually occurs slowly over several years.

      Consider having full mouth implants before that bone shrinks away too.

      Very respectfully,

      Dr. Amin.

      Reply
  106. Rachel

    Hi there,

    I’m having a Dental Implant removed on September 28, 2015. The Oral Surgeon that I will be seeing wants to put a bone graft by the name “Calcium Sulphate” in the socket to promote healing. I was told that this particular bone graft will stimulate my own bone, and the Calcium Sulphate will disappear/dissolve completely. I don’t believe that. Personally, I do not want any other foreign materials in my gums ever again. Can’t he just use my own bone? Is this an option? What should I tell him, and how do I get him to use my bone? I apologize for so many questions. This Dental Implant has not been a pleasurable experience at all for me. I would be honored if you could share your knowledge with me. Thanks, and Kind Regards

    -Rachel

    Reply
    1. RamseyAminDDS Post author

      I am sorry you have had a negative experience. That is so unfortunate. A bone graft is not necessary unless you need it for cosmetics.

      If this is in the front of the mouth, you will be left with a dent in the jaw. This will make your teeth look fake. I would suggest grafting with the culmination of human cadaver bone, cow bone and Prf.

      Your own bone has to be dug out of somewhere in your job in place there. Realistically it will dissolve away so fast that it would not be of any benefit. But again this depends on the location of where the tooth is missing. If it is a front tooth I would suggest some type of bone graft. Calcium sulfate is a very old material but can be useful in some situations.

      Reply
      1. Rachel

        I’m sorry, I never mentioned which tooth it was. It is the bicuspid on the lower-right. So, If he uses my own bone from my body it will dissolve away so fast it will be of no benefit? I’m confused.

        Thank you for the quick response

        Reply
        1. RamseyAminDDS Post author

          The funny thing is that our own bone dissolves faster than bone from a cow or cadaver.

          Each graft is very unique.

          Just be sure to go to somebody who is very well-qualified in implant dentistry. They should direct you on your specific bone needs.

          Reply
  107. Andrew Woods

    Hello Dr. Amin,

    I had a crown that broke with the tooth, so what was remaining was the part of the tooth from gum down. I wanted to know:
    1- Could this have been saved in anyway? The dentist extracted the tooth and performed a bone graft.

    2- I had a bone graft done on the next molar years ago and although painful healed very well. This new bone graft, now has a “crater” look, where the tooth was extracted and food is constantly getting stuck there and after two weeks I still have some pain. I really don’t know if this crater is normal? or if it will heal closed like the other one? I feel that he didn’t put enough material and that the material has receded. He is on vacation for a couple of weeks. Should I wait? If it is faulty can they add to the bone graft, without trouble?

    Thank you

    Reply
    1. RamseyAminDDS Post author

      Andrew,

      this all sounds fairly normal. Let it heal up on its own and then reevaluate before placing the implant with a 3-D scan. Teeth that are broken to the gumline are poor candidates to be saved. They often get a root canal, post and crown only to break within 1-3 years

      Reply
  108. Danielle

    I had a tooth extracted and bone graft done on Monday. The procedure went great and I had no pain until Wednesday. It hurt so much. No swelling and it looks fine. I went back on Wednesday because they wanted to make sure all was well. The dentist said it looks great and is healing fine. It’s Sunday and I’m STILL in considerable pain. It seems to be very very gradually getting better but the pain does peak in the middle of the night. I also still seems to have little granules coming out. No smell or oozing. Is there anyway to know when this throbbing pain will be gone???

    Reply
    1. RamseyAminDDS Post author

      I am guessing you had a lower molar extracted. Lower molars, especially wisdom teeth can sometimes have delayed healing and pain due to inflammation of the bone itself. I’m guessing it is not a wisdom tooth because those are not typically grafted after extraction.

      If you have pain in your ear, you could very likely have a dry socket going on even know the socket was grafted. Of course there are more rare conditions such as osteomyelitis which would occur several weeks after extraction and would make the bone not heal at all. These are unlikely. Follow up your dentist and consider antibiotics for longer duration.

      Good luck

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  109. Ralph Stafford

    Can Zithromax (azithromycin) 250 mg or 500 mg be used in the place of Cleocin (clindamycin) or Amoxicillin?

    Reply
    1. RamseyAminDDS Post author

      Hello Ralph

      Clindamycin or amoxicillin are definitely the best choices for use against the types of bacteria we find in the mouth. Zithromax can also be used in patients that have problems with amoxicillin or clindamycin but it is more narrow spectrum and may not kill all the bacteria in the mouth. I do use Zithromax occasionally in a patient that is allergic to both amoxicillin and clindamycin.

      Here’s a blog post on antibiotics it may be helpful for you.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  110. Janice

    Your article is informative, and has relieved a bit of my anxiety, but will ask you anyhow. Two weeks ago, I had my six remaining front teeth extracted, and my dentist put in bone grafting material into the two larger cavities from 22-28, and dentures placed. All was going well until this weekend, I noticed that I have either bone, tooth or graft material protruding halfway down the gum, the width of a tooth, facing my lip side and this morning notice the same thing happening on the other side, though the tissue is at a point, very red and sore, with no bony like protrusion (yet). Naturally my dentist is out of the office this week, but am considering calling an oral surgeon in the area whom I’ve gone to before if this is what is considered an emergency. My dentist, though I like him and his staff real well, took a very long time to pull the teeth, having a very difficult time doing so, breaking them in the process of removing, and am thinking he may not be real experienced in this area of practice. I’m concerned if it’s part of broken tooth that may have remained, or the bone grafting material coming thru, in any case, putting in my dentures over these spots is extremely painful. Would I be wise to contact the oral surgeon? Thank you.

    Reply
    1. RamseyAminDDS Post author

      Ideally, it would be best to see the same dentist that did the bone graft rather than seeing someone else. They know exactly what was done and what the condition was like before the graft. Of course if you have an emergency and cannot be seen then seeing someone else is advised.

      Whenever you place a temporary denture over the top of healing extraction sites, they tend to heal much slower. I’m assuming you have some sort of a cushion inside of the new denture during the healing process? This is called a soft reline and is often white or pink in color.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  111. edit kovacs

    I had a sinus lift/ bone graft with granules 5 weeks ago. The membrane had been torn so a silicone membrane was placed over it. A couple of weeks agoI ddeveloped kind of allergy attacks and heavy breathing. The implant was removef two days ago but the attacks and heavy breathing stayed. I desperately need advise as dentists in Hungary have never come across a case like mine. I am thinking of the bone graft being infected. How can it be removed? No allergy test yet for silicone and titanium. My sinus membrane has been extremely swallen. The sinusitis I developed is almost gone but the sinus cavity next to my nose on the side of
    surgery is half full. Any advice would be much appreciated. Kind regards

    Reply
    1. RamseyAminDDS Post author

      Silicone is not a material that any dentist would use inside your sinus. Are you sure that is what it was?

      I do and teach sinus procedures multiple times a week and I have never heard of this.

      You may have other medical problems that are masking themselves into the dental problem too.

      Keep us posted.

      Reply
  112. lynnn langford

    i had bone grafting to build bone in top of mouth thursday may 7 its very pain ful its still soft in places getting a denture thursday may 14. I have implants on bottom . DENTIST wanted to build bone in case I wanted implants in the future . Thats two weeks from bone graft surgery to put in a denture

    Reply
    1. RamseyAminDDS Post author

      How can I help you?
      I would highly suggest in the future you have IV sedation with intravenous steroids to greatly reduce information and postoperative pain. This will also allow you to draw blood for platelet rich fibrin and platelet rich plasma to aid in the healing process. This allows me to do dental bone grafting with most patients only taking Tylenol/ibuprofen

      Respectfully,

      Ramsey Amin DDS

      Reply
  113. Megan

    Hello,
    I had a extraction in my upper jaw I believe tooth #2 on the right side about 6 days ago. I have bad bad pain my jaw is tight and I can’t really eat without it hurting. I called my doctor on the 3rd day and told me not to worry. I had a root canal done 8 months before that and after the root canal I still felt everything. Then the tooth got worked on again so my doctor asked what I wanted to do so I told him to pull it. There was a red bubble on the tip of the tooth and the 3rd part was covered in red. He said I had a infection before getting the tooth pulled but I didn’t take the antibiotics. Durinf the extraction I still felt everything. Now it’s 6 days later and I wake up in pain I sleep in pain, a horrible smell is coming from my mouth and particles keep coming out. And just this morning it was all brown. I am on antibiotics which is 300mg and Motrin which is 800mg but they aren’t working at all. I am seeing him today and I am scared that this pain will never go away and I am only 24 years old. Do you suggest I should take the bone graft out?? And what should I ask my dentist?? Please help. Thank you very much

    Reply
    1. RamseyAminDDS Post author

      Hello Megan,

      The pain you’re experiencing is uncommon. Is it possible that you have another tooth that is going bad at the same time? Is a possible that you have an impacted wisdom tooth that is the problem? Something sounds very odd here. Typically membranes and sutures do not fall out 3 days later but even if it did, it would not cause extreme pain. There should not be an odor. You should be able to have a tooth extraction, and socket bone graft without feeling a thing. Be sure to see your dentist ASAP and let me know what was found.

      Respectfully,

      Ramsey Amin DDS

      Reply
      1. Megan

        I had all my wisdom teeth taken out about 4 years ago. It also tooth #3 counting from the upper right side. After doing research I found it is a dry socket which is horrible and painful. I went to my dentist told him it is one and he checked and told me I was right. He took the bone graft and the membrane out. He packed the dry socket with dry socket paste I had it in for 4 days. Then had another one packed in there and it fell out that night. I delt with the pain and also went back 2 days ago to have one last dry socket paste. He said I am in the clear and the dry socket is gone and that my extraction site is healing and closing up. I haven’t chewed or let liquids touch my upper right side. I have a few pain but I asked him if I can have alcohol and or eat he said yes by Saturday. Can dry socket come back by any chance and if so how? Thank you. I also have a cavity on my left side and it’s getting worse because all I do is chew on that side.

        Reply
  114. paulette

    Will the bone being exposed above the left front tooth be corrected after the implant is completed?
    I had a bone graft 4 days ago but the bone is showing above the tooth line on my gum. It is discouraging since its in the front where I smile.

    Reply
  115. yannic

    thanks for this article, it really helped me a lot 😀 I just got a decayed tooth removed and all is going well (has been nearly 7 days now) but yesterday some bone got exposed (a tiny pike on the front) and seems like also a little fragment is coming out, so I was a little afraid, but this article helped me calm down a lot and is very informative. since it’s not hurting or anything I guess I have nothing to worry about, in any case I have an apointment with the dentist in a week to check my progression.

    Reply
  116. Amy Maldonado

    I had 5 extractions and 5 bone grafts done on the 18th of March #’s 7, 14, 15 18, and 19 and after 5 days had to call to schedule myself a follow up appt. something didn’t seem right I had the partial plates in and they didn’t fit right first of all but my breath was beyond what myself or anyone around me could handle! Absolutely horrifying! When I removed the partials to clean with warm salt water I notice greenish yellow stuff oozing from the incision so I went to dentist to see if I had an infection she said oh no everything is healing nicely. I went home and just felt I needed to check the extraction sites of 14 and 15 and placed a mirror in my mouth to look and what I saw were huge black holes with green and yellow pus outside of the holes. # 14 has a hole big enough to stick my finger in. I don’t know if this is normal obviously my dentist thinks so but I was suppose to have had bone grafts and I don’t understand where there would be such a big hole. I took pictures and I was thinking about making an apt with another oral surgeon to find out if the bone grafts were even done and exactly what is going on. Can you please give me some advice

    Reply
    1. Ramsey Amin DDS

      Hello Amy,
      Without seeing you personally, I would not be able to definitively tell you whether things were healing well or not. Your descriptions make it seem as if you do have an infection….. But white coloration is considered normal healing inside of the mouth. Oozing fluid is not considered normal healing.

      Depending on the method and materials of grafting, the hole may feel large to you. Bone is grafted just below the level of the gum tissue and may feel concave…. This would be considered normal for a socket bone graft if this is what you had done. Eventually, your gum will heal over top of the concavity into a very flat ridge like structure which will be perfect for the dental implant.

      I have trained many dentists on bone grafting techniques. Some dentists do this all the time and some only dabble in it…. Those to do a lot of these procedures understand what is normal and what is not and can help you have an ideal dental implant situation.

      Signs of infection would include fever, bad breath, limited mouth opening, swelling, heat around the area. Make sure your dentist for a second follow-up visit if you feel that things are not healing normally. I’m sure they will be happy to accommodate you.

      Socket Bone Grafting….Do I Need It for My Dental Implant? Ramsey Amin DDS Reviews

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  117. Rob Blake

    I think My implant membrane came out after about a week or week and a half. Not sure. Had an xray yesterday 3 weeks in. I thought I may have had an infection. I didn’t Doctor says bone graft looks good. Is membrane coming out going to cause me a problem and is there anything that can be done at this point? Thank you.

    Reply
    1. Ramsey Amin DDS

      Hi Rob,

      I think this post will help you the most. Make sure you see your dentist too!

      basics of membranes and exposures

      Every case is very unique. Sometimes an exposed membrane is done on purpose while sometimes it can be extremely detrimental to the healing of the bone graft. It depends on the technique of the bone graft more so than the type of bone graft material. also keep in mind that many dentists have a wide variation of training, experience and judgment in the discipline of dental bone grafting for dental implants.

      Very respectfully,

      Ramsey Amin DDS

      Reply
  118. Tiffani Stewart

    Hi there,

    I had a bone graft and tooth extraction done two weeks ago. They took a piece of the bone to use in the graft from my lower jaw, right hand side. *Sigh* I took the antibiotics the whole way through, one stitch broke about 7 days in, and one broke where they took the bone from. Anyway, it’s been 15 days today and my lower jaw is still a bit swollen. It’s also a bit inflamed on the inside of my mouth where they took the bone from. I cannot open my mouth as wide as usual, and I feel when I try to like a hard ball is going to break. I am freaking out a bit and can’t see my surgeon for another week. There isn’t much pain, once in awhile it feels sharp for a second but immediately goes away. I also didn’t brush this area the entire time I had the stitches because it was painful and I was afraid of breaking them, bad idea. My dentist was slightly unhappy about that. He also said I created an indentation within the area of my bone graft due to me pressing on it with my tongue. He said this was classic. I’m a bit nervous and worried, I’m hoping I don’t stay like this forever. I’m only 27. I don’t want to have trismus or osteomyelitis….. Is it normal for it to be swollen in this area after 15 days.

    Reply
    1. Ramsey Amin DDS

      Hello Tiffani,

      It sounds like you had an autogenous bone block graft. I have done many of these. Nowadays, I mostly use bone from a tissue donor rather than having to take it from your jaw.

      Depending on how complex the surgery was, you could possibly have pain and swelling for 15 days if it was a really severe case. I’m guessing it was taken in the back of your mouth where you wisdom teeth used to be. This is called the ramus. It is attached to a muscle that makes are mouth open and close called the temporalis. During the procedure, if the muscle attaches to where the bone is being taken from, it has to be stripped off which causes this limited mouth opening for a while.

      As long as the stitches did not open up in the area where the bone graft was placed, it is probably okay. Definitely keep the area clean by brushing it well…. Give it time. It will also heal. I am guessing you just had a very complex case.

      Attached is a link to a post about block bone graft for dental implants.
      Block Bone Graft for Dental Implants 2015 Update-Ramsey Amin DDS Reviews

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  119. Linda Chronister

    Debra: I had one of my big front teeth extracted in early February and a bone graft done. Except for one stitch coming out later and an appointment since…everything seems to be intact. I was told to hold warm salt water to my upper gum several times a day, every day which I did at first, but slacked off. I didn’t confess to my dentist that I had been lax on that and he said “Just keep doing what you’ve been doing – the salt water..and don’t bite into anything with your front teeth” At that visit, he pulled on a stitch and I yellow “Ow!” and his assistant told me that he was going to remove stitches but because I was still so sensitive, he would wait and that some may come out normally themselves. I’m trying to remember to do the salt water but he never told me that that was actually a ‘healing process’ – I thought it was mainly to relieve discomfort. Now, the past two days, my gum right up under my left nostril, feel swollen and really hurts – esp. if I need to wipe my nose! If it is infection or rejection…was I at fault for not religiously using the salt water? My next appointment is not until April – it is March now.

    Reply
    1. Ramsey Amin DDS

      Linda,

      You should not wait until April to see your dentist. You should see him or her now in case you have developed an infection that can dissolve away your bone graft!!!

      Ramsey Amin DDS

      Reply
  120. Debra

    I had a bone graph on a front tooth a year ago. It was out of the state and I will be going back for an implant soon. How do I know before then if it has started to reabsorb or collapsed? Just don’t want to be nervouabout it failing since I’ve waited too long.

    Reply
    1. Ramsey Amin DDS

      Hello Debra,

      The bone graft won’t just fall out. The best way to assess the quality and quantity of the bone graft done 1 year ago would be to take a 3-D scan and have virtual implant placement done. This will allow the dental implant surgeon to know exactly what they’re going into before an incision is ever made. This also greatly depends on what type of bone graft and type of technique that was used for your particular bone graft. In my practice if I have a patient that is going to be delaying treatment for a while, the bone graft is modified in this composition to last longer. Try to get implant done as soon as possible. Waiting beyond 9 months after having the bone graft never really helps.

      wear to the bone come from?
      virtual surgery

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  121. Dee

    Had #3 extracted due to a fracture, dentist packed area with white gauZe and then gave me stiches leaving gauze in my gums. Is this safe? Having stitches removed in four more days. But that will make it 12 days from date of extraction.

    Reply
    1. Ramsey Amin DDS

      Hi Dee,

      This seems a bit odd. Is the gauze infused with some sort of growth factors if it is truly gauze? You sure it is not a bone product?

      I use concentrated blood from your own body to make certain growth factors such as PRF/PRP/PDGF but those are implanted directly into the socket or into grafted bone without the use of gauze to hold in. I would just call your dentist and ask what you had done. It should be very clear before you have the procedure done.

      Growth factors information

      Reply
  122. Kristine

    Thank you for the post.
    My bone graft “failed” in #5 twice.
    I was never given an antibiotic, after grafting.
    I was given one when the implant posts were drilled in, but,
    both times it was days later, because they made me vomit.
    I have had antibiotics before with no problems.
    I was in a ton of pain, that was also ignored.

    Reply
  123. Annie

    Had extraction then bone graft a few weeks later, now, after about a month, i see my bone in my lower jaw, on the inside close to the side/under my tongue, about 4mm wide 3mm in ht. Its oval shaped and its as if the bone compacted and wore out my skin. Its tooth #19 and about 6mm down from top of gum line. Feel it continue to get bigger, as in spreading wider. Please help

    Reply
    1. Ramsey Amin DDS

      Hi Annie,

      It sounds like you have what we call a “bony sequestrum.” It is not uncommon for this to happen on the inside of the lower jaw in the back of the mouth. The gum tissue is very thin in that area.

      I am guessing your not taking an intravenous bisphosphonates such as Zometa which is related to the oral medications like Fosamax, Boniva, and Actonel. If so this can be a condition called osteonecrosis of the jaw… But not likely..

      The condition of exposed bone is typically very easy to treat. In my office in Burbank, I would simply apply a strong topical gel and adjust the bone below the level of the gum. It typically would heal up within 3-7 days after doing that. You need to see your dentist ASAP.

      PRP/PRF treatment may help accelerate the wound healing process tremendously. I use it all the time, especially on areas that may not be healing properly.

      Do you take Fosamax, Actonel or Boniva? What You Need To Know Before Having Dental Implants
      PRF/PRP treatment

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  124. Padmini Ramlal

    I had a upper teeth removal by back of my mouth a few days backand saw a piece of scab fall out when eating. Its not really a big piece but should I be worried

    Reply
    1. Ramsey Amin DDS

      Hello PR,

      Fortunately dry socket which is formally called alveolar osteitis is not common in the upper jaw. I would not worry about it too much. Loss of a blood clot in the lower jaw especially on the lower wisdom tooth can develop a very painful condition which many know as a dry socket.

      Wisdom Teeth Extractions

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  125. Nicole

    Hello,

    I recently had a bone graft to widen my bone for a tooth implant, I just had a proper look at my teeth after 4 days and am a bit concerned over how much white is actually showing in my upper gum, after reading you article and looking at the pictures I’m still really unsure whether the gum will eventually grow over the bone or if I need to get another procedure done for the gum to cover it all, I know it’s early days but I’m just curious

    Reply
      1. Christian

        Thank you Doctor for your time and advice, this site is realy informative and helpful.
        I had my bonegraft a month ago in preparation for implant, my doctor used a cadaver-bone block for my upper jaw (front). Im worried cuz some part of the bone was not covered with gums, i can even see the metal screw on the bone. I went to my dentist and he told me i have a weak gum. He did some sutures and made me use gengigel, he told me to comeback after 3weeks as he is going on vacation. It scares me cuz its been 1week now and the gum still not closing in that area. What should i do? Im not feeling any pain except for pressure where the bone graft is, and i cnt see any infection too. I badly need your advise, thank you very much.

        Reply
        1. RamseyAminDDS Post author

          Here is some more information about bone block grafting. If the wound became exposed, it is only going to get larger unless it gets cleaned and the dead bone removed. Any bone that is exposed is dead.

          The bone block graft is a very technically demanding bone graft. You have to be absolutely certain that the temporary does not touch the gum in any shape or form on the graft during the first month. Typically pain is not felt when a block bone graft gets exposed.

          Thin gum should be treated with a preoperative or simultaneous gum graft and can be padded with L PRF membranes. The gums must be closed without any tension whatsoever or the pressure will just rip it open once it swells a bit. You need to see someone soon. Do not smoke all if you do

          This applies if you truly had a block bone graft using fixation screws.

          Good luck,

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

          Reply
  126. Rebecca

    Your site is helping me put my mind at ease. I have a great oral surgeon, I trust him. However, I wish I could have been provided with some pictures so I could gauge my healing progress- just had #30 extraction October 15 with bone graft, sutures and antibiotics. After four, going on five days now, I still have pain and a bit of swelling. I don’t, and have not seen a blood clot. Because I have a bone graft and sutures I am hoping this is normal. I see yellow and white. Pain is relieved with Motrin. I know one suture definitely came out on the third day. I am worried now because I feel a bit of an indent at the extraction site- I am not sure if I should feel graft material packed to the top or what- I was looking for answers and this is how I came across your site.

    Reply
    1. Ramsey Amin DDS

      Hello Rebecca,

      It sounds like you are 5 days out from the tooth extraction when you wrote this comment/question. Everything you have sounds within range of normal. Even though a suture came out and you feel some small indentation that does not mean that your bone graft has failed or anything needs to be done about this. I’m sure when you see your oral surgeon, he or she will tell you the same.

      There is a chance you may have an infection which would require additional antibiotics or worse case scenario removal of the bone graft altogether.

      Dental Implant Bone Graft healing -What to Expect

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  127. Jaime

    This blog is really nice.. it seems like you put in so much time over the last 5 years into educating patients. Thank you so much for all your help!

    Reply
  128. Josh

    Very informative article. As a periodontist I believe it’s crucial to provide a series of progression photos for the treatment process.

    Reply
    1. Ramsey Amin DDS

      Thank you Dr. Josh!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply