Bone Grafts…How Long Do They Take to Heal? Dentist in Burbank Video

Some bone grafts for dental implants take longer to heal than others. In this video, I cover several factors that determine how long your bone graft takes to heal.  Remember that many times the bone grafts and dental implants can be done simultaneously.


 

 Factors

  • Number of walls missing
  • Upper or lower jaw
  • Type of bone material
  • Membrane type
  • Block or particulate bone
  • Rebuilding height, width or both 
  • Concurrent gum graft

Most bone grafts are ready for dental implants 4 months after the surgery. Some will need 7 – 9 months.

Feel free to ask questions below!

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com

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339 Responses to Bone Grafts…How Long Do They Take to Heal? Dentist in Burbank Video

  1. Laura says:

    Is it normal to lose a few granules of the graft materiel during the healing process? I had a graft on my lower jaw just under 2 weeks ago. It went well, with relatively no pain. Stitches were removed at one week and all looked well. Gums are healing nicely but occasionally during the day I will feel a piece of the graft materiel working it’s way out of the area. Is that something to be concerned about?

  2. Hi Laura,
    It is VERY normal to have some granules of bone graft to come out over the first few months.
    Dr. Amin

  3. Carolynn Lewis says:

    Hi! I need dental implants in the lower left area to replace two molars and a bi-cuspid. My oral surgeon wants to take a block from the right side of my jaw to place in the area to make it higher and wider. He never mentioned anything about my gums. The teeth have been missing for about 20 years. My concern is that I am not going to have enough gum tissue to pull over the bone. Should I ask him about this? Also, the area where the bone is taken from, does that also take about 6-9 months or so to heal? Thank you so much.

  4. Nancy says:

    I consulted a Prosthodontist about an implant for a missing front tooth that is apart of a three crown bridge. Years ago, I had dental surgery and braces to correct an overbite. The overbite never was corrected to the level I wanted. The Prosthodontist told me he could do an implant and bring my bite in but would have to crown a perfectly good tooth in the process. Because the two teeth on my crown have root canals, he could bring them in but the forth tooth on my left (the good tooth) would stick out. He suggested crowning that tooth. Could I do braces instead of destroying a perfectly good tooth? What are my options?

  5. Hi Nancy,
    Braces are almost the best option in conjuction with having an implant. Consider it!
    Good Luck,
    Dr. Amin

  6. Hi Carolynn Lewis,
    Great questions! In many instances, your existing gums can be “released” in order to cover the new volume of bone.
    A gum graft is usually done for front implants, but is sometimes used in the back.
    When I have to do it, I often try to combine the gum and bone graft together.
    Does this answer your question?
    Dr. Amin

  7. Phil Greco says:

    Hi Dr Ramsey,
    I had a bone graft about 7 weeks ago (tooth #7) and still have swelling and alot of soreness. My Dr. supsected a sinus infection because the e-ray was clean and showed no infection. But strong antibiotcs have done little to help if at all. How often does a bone graft not “take”. And when this occurs, how is it best resolved? Thank you in advance for your time.
    Phil G.

  8. Hi Phil,
    What antibiotics are you on exactly? Tell me about your current and past medical history.

  9. Sophie says:

    Dr Amin, I had implants 3 months ago. Today my dentist told me I might need bone graft. Is it normal? I thought bone graft is done before implant. Does that mean the implant failed? I am very nervous. My implants are for upper #7&10. They are missing from birth. Thank you!

  10. Hi Sophie,
    Bone grafts can be done at any time! No worries!

  11. marea says:

    will i be able to tell when the bone graph is healed? Also the gum about the bone graph is staarting to pulseate

  12. The healing of your bone graft is best determined by your dentist. Keep him or her abreast of any signs or symptoms.
    Dr. Amin

  13. Alyssa says:

    Hi. I was supposed to get the process started earlier this week. I got my wisdom teeth out and I guess there was not enough bone. It is my upper front tooth, my surgeon has not told me how long it would take. I really wanted to be done with this before college! What is a bone graft made of and what color is it because i have white stuff where the graft is. I am rinsing and it is’nt coming off.
    Should I be wearing my retainer? i think it would hurt. Thanks

  14. Darnell Gimenez says:

    I have been going through dental implants and so far they have not worked. They keep having to take it out or move them. My last problwm was the implant went up into my sinus and they could not get it out. They stitched me up and said we would have to wait till it came down. 2 weeks later they opened up the gums and dug out the implant it was horrible. Have you ever heard of this happening. Portions of my gums and roof of my mouth are still numb and some parts still hurts and it has been 2 months since they dug out the implant, is the numbness and tenderness normal? Now they are going to try a block of bone to build it up and try 2 more implants and I am scared of going through more of the same. It has been 1 1/2 years since they started. What should I do

  15. Hi Darnell,
    Continue to see your dentist. Although it may be a long road, it should work out in the end.

  16. Hi Alyssa,
    Your questions are very general. I would need to see you for exact times.
    Typically, the process will take a few months! Hang in there!

  17. La Verne Brown says:

    Hi Dr. Amin,
    just 6 months ago I had jaw surgery to correct an extreme over grown lower jaw. Now I want the teeth i have lost many years ago to be replace because now that my jaw has completely changed I wonder if any of my procedure will be considered reconstructive instead of cosmetic.
    La Verne B

  18. Hi LaVerne,
    It is possible though unlikely. In my Burbank dental implant practice, medical insurance rarely picks up dental implants or bone grafting.
    It is worth a try though, but don’t get your hopes up.
    Sorry!
    Ramsey A. Amin, D.D.S.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow of the American Academy of Implant Dentistry
    Burbank, California

  19. Jimmy says:

    Is the extraction and bone Grady procedure something a competent dentist can do, or is it best be done by a surgeon? Any insights on it’s complexity and who should do it is much appreciated..
    Thanks
    Jimmy

    • Hi Jimmy,

      Every dentist is different. It doesn’t matter on their specialty but rather on their training, judgment and experience.
      Spend time researching the right dentist for you and your situation but I cannot emphasize enough how wide the difference in experience can be. Some dentists do this 1000 times a year and some do it twice yearly.

      I hope this helps!

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

  20. Nina Malik says:

    I had bone grafting done three weeks ago, today my stiches were removed and filler/splint was added to my front and two side deeth. I am not very comfortable with splint but it was nesseccary as my teeth had too much of a bone loss. Can splint be removed once teeth are strong and sterdy?

  21. Anna says:

    Hello, I am having surgery to remove ten unexposed teeth from below the gum (lower), and these teeth are crowed beneath where numbers 22-27 would be. The surgeon will remove these teeth and fill in the void with bone graph, and I am wondering how long before I could talk comfortable to work again.

    • Hi Anna,

      This question would best be answered by your surgeon that has examined you and seen your x-rays or CT scans.

      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

  22. Julie says:

    Hi, I had my back right molar extracted and grafted a few months ago and then the
    Tooth in front of that the same surgery 6 days ago. Iam having a tremendous amount of pain this time, is this normal? It is a deep seated aching pain, Iam taking Pcn vk for an abx and only have one day left. Thank you for your time.

    Julie A

    • Hi Julie,

      I think you should call your dentist so that he or she can diagnose what is going on and actually see you. Some extractions can be very painful.

      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

  23. Jim says:

    Dr Amin,
    I had a block bone graft done along with a gum implant on the front upper part of my mouth. Unfortuantely the suture popped and I had to have another surgery, and the doctor removed the bone graft and replaced it with a synthetic material. It has been 5 weeks since this and the area around my mouth is still raw. How damaging are the effects of smoking on a jaw implant and how long would you recommend abstaining from smoking?

    • Hi Jim,

      Smoking impairs the healing of bone. If you smoke more than 10 cigarettes a day, you can have problems with advanced bone grafting. For a block graft, you should abstain for 1 month after surgery and 1 week before surgery.

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

  24. Jestina says:

    In March 2005, I had two implants either side of my lower jaw to replace two molars, three months later the crown was fitted. Literally, within weeks, the crown became loose on one of them and the gum around it was red raw and extremely painful. I went back to the dentist; he screwed it in, which surprised me. I thought he would have removed it and treated the area. Ever since, I have had constant problems. The main one being a feeling of numbness in the area. I can only describe it like the feeling you get when a dental anaesthetic is wearing off. This has gone on for years. The dentist burnt off some of my gum, that didn’t work. Six monthly check ups and x-rays found nothing but he mentioned peri-implantitis . Two years ago, he removed the crown and I believe treated the area with citric acid. Nothing worked. I continued to suffer numbness and sporadic bleeding of the area when I brush my teeth. I asked for a referral a few weeks ago and a peridontist identified pus, bone loss and implant failure. He removed the implant and did a bone graft. Two weeks after the bone graft, I am still experiencing that feeling of numbness. I am now worried that the bone loss is irreversible and I have to spend the rest of my life with a numb jaw, which whilst it is not painful just doesn’t feel normal. Can you help ?

  25. Jestina says:

    Dr Amin, an additional question to my last one above (Jestina). The peridontist said that after the bone graft, i should experience swelling approx 3 days later, he offered steroids which I duly accepted. The dental nurse gave me four tiny tablets of 5mg or 15mg of something. Do you think that in taking the steroids, it had a negative effect on the graft ‘taking’ ? I know it seems a silly question to ask but although I was in agony after the bone graft, I experienced no swelling. I now fear that the bone graft was useless, the bone won’t grown back so I can’t have the implant reinserted but worse I am left with the numbness in my jaw which feels like a ‘freezing’ effect. I’m devastated with worry.

    • Hi Jestina,

      It sounds like everything was done properly including the steriods. Did the numbness happen after the crowns were put in, or after the implants were put in the bone? This will help me to help you.

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

  26. Jestina says:

    Thanks for replying Dr Amin. When I had the implants fitted, it was left for a few months for the bone to fuse to it. Everything was perfect. No numbness was felt in that time at all. However, weeks after the actual crown was fitted, one of them become lose, the gum was very inflammed and it was impossible to eat on that side. In between going back to the dentist for him to address the inflammed bleeding gums and discomfort, that is when I started to feel the numbness, well it’s more of a frozen feeling and it is just in the implant area not the whole side of my mouth. It has now been 4 weeks since the bone graft, it is healing nicely but the frozen feeling is STILL there. At very odd times, it feels like the numbness is subsiding and funny enough the numbness is less pronounced in the morning. Do you think that as time progresses and the bone hopefully grows back that the frozen feeling will go away ?? It’s just two weeks ago, the dentist was slightly concerned that I was still feeling numbness. By the way, the other implant has never given me any problems at all.

  27. Jestina says:

    The peridontist thought the same thing !! And he has said to leave it for another few weeks and if it does not subside then he will refer to me to doctor specialising in dental nerves etc. Thanks for your help.

  28. Sandra says:

    Dr. Amin,
    I had a bone graft and immediate loading at the same time done 2 days ago in both side of my upper No. 1,2 . my dentist recommend to do the bone grafting for a better result of my dental implant, since my gums were shrunk and the bone is thin. now i don’t feel pain even after the procedure but my face is still swelling is it normal? i inform my dentist regarding this matter but he said that it will occur 3 to 4 days because of the bone grafted. thank you!

    • This sounds fairly normal.

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

  29. Chelsey says:

    I had a tooth extraction and a bone graft done a couple days ago and it’s very painful and I’ve been having a foul taste in my mouth from it. I’m on antibiotics right now because of an infection that was present before the tooth was extracted. He has me on cephalexin. Is the bad taste normal? If so, how long before it should be gone? Also, would having a bone graft done right after an extraction make the healing process quicker or longer?

    • Hi Chelsey,
      The bad taste can be from an infection or it could be a side effect of the antibiotics. What did your dentist say?
      Having the bone graft and the implant on the same day, usually shortens the procedure time.

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

  30. Anne says:

    Dr. Amin
    I am missing #2 and #3. The Periodontist who evaluated me said the ridge is deficient in both vertical and horizontal dimensions. He recommends split ridge augmentation and implants. He plans on using cadavrs material for bone graft.
    I am 66 years only and have severe osteoarthritis (hips and knee). he estimated 12-24 months to complete.
    I am very nervous about the risks involved in going forward with the bone graft and implant.
    What are the risks of doing nothing.

    • Hi Anne,

      This is a massive question. Generally speaking the risks of doing nothing are worse than the risks of the dental implant bone grafts. As you loose more teeth, the situation worsens with more bone loss, tooth movement, and bite collapse.

      Have you taken Fosamax?

  31. nick says:

    I had an extraction with bone graft done the same day on a top back molar. It was three weeks ago, and still have moderate to severe pain in the area.
    The pain comes and goes, but when it pulsates in it is almost as bad as before the tooth was pulled.
    I’m due to see the doc. in two weeks for the ‘4-6 week check up’. Should I wait till then and hope it heals up and feels better? Or should I be more urgent about the matter and get an emergency appt. with him before then?
    I’m afraid of jaw infection and spreading to other teeth. The first two weeks I took pain meds and was fine. Now three weeks in the pain is still there. It seems healed and closed off, and the pain is coming somewhere from within the jaw bone…. Thank you for any help in this. Its 2am and my dentist is out of reach….

  32. mae says:

    i had a bone block grafted on my upper left canine and right lateral incisor a week ago, my gums are are now healing. but the gums on my lateral incisor were stitched tightly, it is stretching when im smiling or laughing and it hurts a little, will it go back to normal?!

    • As long as the gums stay closed, all should be good. What you are experiencing is normal. Keep me posted!

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

      • mae says:

        thanks for the reply.
        im now on my third week of healing and i noticed last week that the bone is sticking out of my gums?! is this a sign of bone rejection? how early to tell if it’s a bone rejection? my dentist is not so cooperative as she is due to deliver a baby soon. im thinking coz the sutures were accidentally removed on my second week when i was gargling so the gums was quite open and healed open so the bone was exposed. but right now, it is not swollen and not hurting.

        And also, on my canine part heals fine, but I noticed that I can see through the gums the screw of the bone. Is this also normal?

  33. Debbie Coghill says:

    I had my lower right canine removed last month at which time they also found and removed a large cyst. The tooth was dead. Now I have a large hole there and the flipper doesn’t cover it. I think I will do the bone graft soon but then leave town for 3 weeks. Will I be in much pain? Do sutures need to be removed? Can I wear the flipper after the bone graft? This is all so overwhelming. I will be 60 this year. Thank you.

    • Hi Debbie,

      The unknown can be a bit scary!

      The timing of the bone graft is best determined after examining the type and location of the bone defect. Usually sutures that dissolve are used. Pain really depends on the difficulty of your unique procedure and the skill if the implant dentist.
      You can wear the flipper during the whole process, just dont sleep with it in.

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

  34. Jessica says:

    Hi Dr. Amin,

    I just recieved two bone grafts on Wednesday in preparation for dental implants, I’m congenitally missing both my lateral incisors. Everything seems to be going well, little to no pain but the membrane is peaking through slightly on both sides… Is this normal? Also, my flipper no longer fits, is this due to swelling or have my teeth moved? I haven’t had it in since the graft, if its due to swelling, will i be able to wear it in a couple days? Thanks for your time!

    • Hi Jessica,

      I would advise you not to put the flipper back in until you see your dentist. Pressure from the flipper can cause failure of the graft! If the membrane is a dissolvable type, it should be fine although we prefer it to stay covered.

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

  35. Pj says:

    I had a bone graft after my upper molar extraction a month ago. Everything seemed to be healing well until this past week or so. I have these very sharp fragments (6-8) of bones? protruding from my gum ridge. The pieces literally cut my finger when i touch them. I’m also tasting slight pus. Is this normal? Please advise. Thank you in advance. Pj

    • Hi PJ,

      It sounds like you have a socket graft that is slightly infected. This is not uncommon and can be easily treated by your dentist as long as your immune system is functioning well!

      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

  36. Pj says:

    I forgot to mention that there is no implant involved. Implant scheduled for 2 months from now.

  37. Kim Norman says:

    Dear Dr Amin

    I had a bone graft done a month ago on the left upper side of my jaw, and everything seems fine up until now.

    One week ago I had another done, on the right upper jaw this time I still have numbness on my chin and swelling around the lower jaw, although no pain.
    How long does it take for the numbness to go and should I be concerned yet about this?

    Also, the dentist says that I need a sinus lift on the right upper jaw and will do that when he places the implants in 6 months time. Is this correct as I have read that implants cannot be placed for several months after a sinus lift has been done,

    Many thanks.

    Kim

    • Hi Kim,

      Be sure to talk to your dentist about the numbness. It sometimes happens, even on the upper jaw.

      The implant and the sinus bone graft lift CAN be done at the same time in the hands of a very skilled dental implant dentist. It depends on how much bone you have naturally.

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

  38. Amanda says:

    Hello Dr. Amin,
    I had an extraction, dental implant and bone graft of my left upper canine performed 7 days ago and during hygiene this evening the stitches came loose and fell out. Now the area where the stitches were tightly tied has a “horseshoe” look to it where the gum is not fully together. You can see the metal of the implant as well. I emailed the Dr. who performed the procedure as well, however seeing that it is a weekend, I am doubtful to get a response. Is this an abnormal healing response?
    thank you,
    Amanda

    • Hi Amanda,

      The stitches they used probably are supposed to dissolve after 7 days. It is not uncommon to see the implant after it is placed. It sounds normal!
      Was the plan to bury it for some extended time period?

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

  39. TCF says:

    I am so distraught! I lost #8 at 13 yrs, and then had an implant placed in 2002. I was too afraid to proceed, so I didnt attempt to have the crown completed until 2008. It was VERY unsucessful. I was told the the implact was placed too facially. Since then, I have gotten 2 infections in #8 and recently I (3 days ago) I had a graft done.

    My issue is whether or not I will be able to achieve an aesthetically pleasing final restoration? Would a custom abutment be of any help? I mean it’s #8…DEAD SMACK in the front. Honestly…the flipper looked better to me! Perhaps I had just gotten used to it.

    I miss being able to smile.

    Any input would be appreciated.

    TCF

    • Hi TCF,

      The delay of 6 years probably is adding to the difficulty. Have they considered removing the entire implant and starting over? Sometimes bone lost around an existing implant is hard to rebuild. I try to put a lot of extra bone on the outer wall to make the bone stable for the long term and tilt it towards the tongue a bit.

      Are you local enough for me to look at you to see if I can help?

      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

      • TCF says:

        Good Evening Dr.Amin,

        I really wish I was close to you. I’m in Boston. I just want to get this taken care of. I do have a quick question….if the bone is successfully regenerated, what would you suggest be the next step to a nice final restoration?

        Thank you so much

        TCF

        • Hi TCF,

          Without seeing you, this is a question that can not be answered precisely. The next step should be to follow the treatment that your dental implant dentist has developed.

          Sorry!

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

  40. Kim Norman says:

    Dear Dr. Amin

    Many thanks for your quick reply. I do appreciate this.

    I have read that if there is a problem still within 3 months, surgery can be done to re-connect the damaged nerve. Is this possible?

    Also, may I experience the same numbness and possible long term complications when I go ahead with the sinus lift and dental implants?

    I am so nervous now, that I may not go ahead, but I will be left with upper temporary teeth on my upper jaw. I may even consider, having everything removed and a denture placed as a last resort.

    Thanks
    Kim

    • Hi Kim,

      Yes, it is possible. Although uncommon, there are risks and complications that can and do occur with dental implant surgery.

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

  41. Karina says:

    Hi Dr. Amin,

    I had a bone graft done in the front and back of my chin area (from canine to canine) 2 weeks ago. In my first post-op, there was no gum recession, and the periodontist said I was healing really well. However, there is noticeable gum recession in the front now. Will the gum possibly grow back to cover the receding area as it heals more?

    I will really appreciate it if you can answer this question. I have been very paranoid about the gum recession.

    Thanks a lot!

    • Hi Karina,

      Often times the gum is purposely positioned really high after the surgery. This is often done in anticipation of normal contraction of the gum flap. As long as the bone is not exposed, it may be normal. Your dentist will take good care of you.

      Dr. Amin

  42. concerned says:

    Had sinus lift one week ago and still bleeding a little bit. Feel a little throbbing. Went for checkup with periodontist and he said bleeding is normal. Is that right????

  43. Dorisa says:

    I had a bone graft one month ago in my lower side but i dont see any difference my teeth are the same than before the surgery….Do you think. I have to redue again? please help me!!!!!!

    • RamseyAminDDS says:

      Hi Dorisa,

      Not all bone grafts make a visible difference on the outside of the gum. Many are internal and within the bone.

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

  44. J says:

    Hi,

    Had a bone graft after an extracted tooth on my lower jaw on Friday afternoon, it is now Sunday night, and the stitches are coming loose…. what should I do?

    Thanks

    • Ramsey Amin DDS says:

      Hi J,

      Sometimes this is normal. If the area was swollen and is now decreasing in swelling the stitches will loosen by default. You will probably be fine.

      Most times I put many backup stitches in case one becomes loose. Having a few extra is a good thing.

      Also suturing technique by your implant dentist is critical over bone grafts. Usually a vertical or horizontal mattress is the method of choice.

      There are also many different types of stitches. Some are weak and dissolve on their own in 3 days while others last 3-4 weeks.

      Suture choice is very important.

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

  45. Glen Lazalier says:

    I have moderate osteoarthritis and am 71 years old and would like to get a molar implant but I need a bone graft first. How much do these two factors increase the risk of a bone graft rejection?

    • RamseyAminDDS says:

      Hi Glen,

      Arthritis is usually not a factor unless it is a the rheumatoid form. Osteoporosis is a much bigger deal.

      I wouldn’t let it concern you. Go ahead and have the bone graft and implant.

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

  46. Liliana says:

    Hello,

    Yesterday I have had my second bone graft and I am experiencing unpleasant oddorly drainage. I am on penicillin and prescribed mouth rinse. Is this odor normal?

    Thank you.

    • RamseyAminDDS says:

      Hi Liliana,

      You should see your dentist ASAP to determine this. Some people get temporary bad breath after oral surgery but drainage is typically not a good thing.

      Good luck.

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

  47. Barbara says:

    I had particulate bovine bone grafts (mixed with a small amount of bone bond) done on teeth 2-5 and 9-12, not to prepare for implants but because there was significant bone loss (especially on 2-3) and I wanted to stabilize the teeth for the long term. Three months later, there is no sign of bonding material or bone growth in digital xrays. Does that mean there will be no bone growth? I am getting conflicting answers from the original surgeon and another oral surgeon I consulted. The original surgeon says the type of xray makes a difference, digital being better because old style xrays can slow or halt the growth of osteocytes. The consultant says that is not so, and that if there were bone graft material or bone growth at all, it would show up in the xrays. He feels that the surgery is a failure. I’m not sure who to believe. Thanks for your help.

    • RamseyAminDDS says:

      Hi Barbara,

      Three months for your type of bone graft is too early to tell. It sounds like you had grafting to save your existing teeth.

      Some bone shows on X-ray and some does not. The X-rays are not going to kill the bone cells. That is information that is 30 years old.

      The most important thing is did the bone graft eliminate the pockets? Do the pockets bleed when they are measured anymore?

      Give it time and check back with me in a few months.

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

  48. Balraj says:

    Hi Dr. Amin,

    I am a uni-cleft lip/palata patient who underwent bone graft from the hip to the upper jaw (cleft area). This is about the 3rd graft done. 1st one was from hip, 2nd from chin, and 3rd again from same hip. My last surgery was in 2007 with bone taken from chin and upper jaw moved forward. Didn’t go as expected and maxilla or rather the teeth were slightly mobile (meaning you can take your fingers and try to shake your upper front teeth and will notice a tiny mobility). Eventually, OMS said to to remove left incisor and canine (which was done last year), let area heal, and do bone graft in order to to do implants. Surgery was done on November 14th. Recovery seemed to be fine until I met OMS yesterday and he said everything looks good except he didn’t like how the bone was exposed a bit (said that it had opened up a bit). So what we can see was “white part” near cleft area which was bone with gum around it. He said not a big problem and gum should brow over it eventually but he suggested we stitch it back together. Local freezing done at his office and he put some nylon stitches to partially close it off. It looks to me like I can still see the white part but there is a lot of stitches around so it is hard to tell. He prescribed apo-clindamycin to prevent infection and peridex for oral rinse. He mentioned to keep area clean and this is not uncommon. He said what we see is about 1/5th of the bone he put it. I am so worried as this was a big surgery and don’t want any problems. Does this sound normal to you ? Any help appreciated.

    • Balraj says:

      and also will the gum grow over that bone over time? anything i can do to help blood supply to the area in order for things to start growing over and healing?

      • RamseyAminDDS says:

        Hi Balraj,

        A cleft is very difficult to deal with. Bone should remain covered while it heals. Exposed bone will typically die and need to be removed. The more surgeries you have in the area, the more scar tissue develops. It is a double edged sword.

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

        • Balraj says:

          thanks for the response..will the gum not grow over that bone, my OMS mentioned to keep infection free by keeping area clean and gum should grow over it ? i had similar procedure back in 07 when bone was exposed a bit like this as well and they usually just scrape it off. When you say remove, will that mean another huge surgery while being knocked out? do you recommend to keep grafting or possible move over to dentures/bridges, what would you suggest is best (least problem free down the road) solution to this?

          thanks again

          • RamseyAminDDS says:

            Hi Balraj,

            Scrape and remove will mean the same thing if the exposed bone is limited to a small area.

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

  49. Elizabeth says:

    My dentist wants to perform a root canal on tooth #31, & on the same day do a core build up, crown lengthening, place a perio membrane, apply Arestin, & do a crown prep. He says it will only take about 90 minutes. Can all of this be successfully done in such a short time on the same day? I had another dentist years ago who did a crown & root canal on a molar & he had me come in for several appts. because there were 3 canals & he wanted to make sure the tooth wasn’t going to act up & the root canal would be successful. Please advise because I don’t live far from your office, & I’m not sure this long, drawn-out process can be done in one sitting(with a return for the crown to be delivered.). Thank you in advance because I’m really uncertain.

    • RamseyAminDDS says:

      Hi Elizabeth,

      Wow, that might be a bit bold to do all in one day. If a membrane is involved, healing time needs to elapse.

      I would recommend doing one step at a time. Why rush treatment on your body parts?

      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

  50. John says:

    Hi,
    I am going to have my bone graft done 2 weeks later and my surgeon told me that he will only know whether the bone graft is success or not after placing the implant. This is really surprising because I thought he should be able to know by taking x-rays in the early stage but not during the implant procedure, right?

    Thanks.

    • RamseyAminDDS says:

      Hi John,

      In the early stages the X-rays will not show you success. What it looks like in real in the first few weeks is a better indicator for a bone graft for dental implants.

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

  51. diane says:

    I have been told by my dentist that 3 teeth will need to be taken out and i will need to have implants to replace them. I thought i would have time to research everything that needs to happen but alas my teeth have actually started aching and need to get them pulled pronto. I will not be able to do the extraction and bone grafting at same time due to finances. Is it possible to have the extractions done now and then after a month or so have the grafting done? Will i have already lost too much bone in that time?

    • RamseyAminDDS says:

      Hi Diane,

      The bone graft, if needed, can be done later. Building back bone in stages is very common and in some cases the preferred method. Sometimes the graft is done at the same time as the extraction or implant.

      It all really depends on your unique situation.

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

  52. Mimi says:

    Dr. Admin,

    I had a tooth extraction (31)and bone graft on the same tooth 7 days ago, and I am still experiencing a lots of pain. I am taking amoxicillin 500 mg and ibuprofen 600 mg. I had swelling for 4 days, and is going down now, but the pain is still there. I cannot go without ibuprofen every 8 hrs. Is this normal? I am concerned about non stop pain unless under pain killers. Thank you so much.

    • RamseyAminDDS says:

      Hi Mimi,

      Your pain is likely from the extraction NOT from the bone graft.

      You may have a dry socket or an infection. I can’t speak for all dentists or situations but the majority of my patients tell me they had little to no pain after bone grafts and extractions.

      Were you given IV steroids?

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

  53. Brendon Ladewig says:

    Hi Dr. Amin

    I went for bone graft surgery 6 and a half weeks ago following the removal of a radicular cyst and tooth extraction in my upper jaw. The bone material used was bone granulation or bone sugar as my surgeon calls it. My surgeon says I must not smoke at all during the 6 month healing process….but I read earlier in these posts that I must wait a month after surgery. Can I go ahead and continue to smoke or should I take my surgeon’s advice? Another question I wanted to ask is at this stage in my healing process…has the bone started to form yet?

    Thank you so much

    Kind Regards
    Brendon

    • RamseyAminDDS says:

      Hi Brandon,

      I would do what your surgeon says. Bone is already forming in its infant stages and smoking impairs bone healing. Do your part to increase the chances that this will work for you.

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

  54. Boyan says:

    Hi Dr. Amin

    I had a bone graft surgery in the sinus area 2 weeks ago. All seemed fine until 2 days ago when the area swell, although I didn’t feel much pain. My dentist put me on a 4 days co-amoxiclav course, but I’ve read that the usual antibiotics course for a graft infection is 14 days. I am now in the third day of taking antibiotics and the swelling subsided a bit, although not completely gone. Should I seek the second opinion on the length of the antibiotics course?

    Thank you so much.

    Best regards,
    Boyan

    • RamseyAminDDS says:

      Hi Boyan,

      Did you have a lateral window sinus or did you have an internal sinus lift bone graft?

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

  55. Boyan says:

    Hi Dr Amin,

    It is lateral window sinus.

    Bojan

    • Ramsey Amin DDS says:

      Hi Boyan,

      Usually the lateral window sinus bone graft for implants has a longer course of antibiotics than the internal method. One to two weeks is normal. I hope you are healing up well now.

      I have been doing sinus bone grafts for more than 10 years and they very successful when done properly.

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

  56. Dawn says:

    HI Dr. Amin
    I had four bone grafts done on my teeth at the end of November ….all of the teeth are on the lower right side of my jaw. I don’t have the exact numbers, but two are closer to the front of my mouth and two are at the back…there is a gap between these sets of a tooth that was pulled many years ago. So far, everything seems to have gone fairly well up until now. The gum over two of the bone grafts (front) have closed over the membrane as they should…the back teeth have taken longer to heal but shows signs of beginning to close slowly in the last few days – however the membrane is still clearly visible. Is it normal for the gums to take longer to close on the bigger teeth in the back? Also, it looks like there is a sliver of bone graft coming through the gum at the top of the biggest tooth above the membrane. Right now it seems to be pushing through the gum itself at an angle. Is this something that will come through on its own or do I need to see a periodontist to have them remove it. So far there is no pain or swelling around it but there is a little bleeding when I swab the area with peridex. My regular periodontist is out of town until the 11th and I would need to see her emergency backup before then.

    I do not smoke or drink at all and have a temporary flipper over these teeth to protect them. I have been chewing on the other side of my mouth…is it possible that the motion would aggravate the surgical site on the opposite site? Since my gums have stopped swelling, the flipper no longer fits as tightly as it used to.

    • Ramsey Amin DDS says:

      Hi Dawn,

      Sometimes a membrane is purposely left exposed. This would be common in a “socket bone graft.” In other types of grafts, membrane exposure would be a bigger problem.

      It is not uncommon to lose some particles of bone from the top of these types of graft. I am assuming this was not an onlay block bone graft. Your dentist will likely remove them.

      Don’t wear the flipper! If you don’t need to wear it. They can cause major complications!

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

      • Dawn says:

        Hi Dr. Amin
        Thanks for your explanation. It was a socket bone graft so I am relieved that this was normal. I went to the periodontist on Friday who said everything was healing normally…what I thought was a bit of bone peeking through the gum was actually a bit of the membrane so they removed it as it was beginning to fold over at the top as well.

        Unfortunately, due to the original design of the flipper (full mouth) and some extensive tooth loss I have to wear the flipper. Do you have any suggestions at all to help with making the flipper safer to wear? My primary dentist suggested putting a small piece of gauze under the ridge of the flipper so that it does not rest directly on the gum.

        Thanks
        Dawn

        • Ramsey Amin DDS says:

          Hi Dawn,
          The flipper should be relieved to have a bit of space and/or a cushion reline material if possible.
          Good luck!

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

  57. Tracy says:

    My daughter had bone graft/implant surgery six months ago. She had to have surgery again and the doctor said that the bone was decayed. Why would it decay at six months?

    • Ramsey Amin DDS says:

      Hi Tracy,

      The word decayed is a bit strange. Are you sure this is the word the doctor used? My guess is additional bone volume is needed and or the graft shrunk.

      Sometimes you have to build bone back in stages rather than in one fell swoop. Just because bone is placed in the area doesn’t always mean that it will take 100%.

      Sometimes it only grows 80% and the other 20% needs to be added at a second procedure. Our bodies all respond differently!

      I hope this helps!

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

  58. Chris in NJ says:

    I had a bridge on 13,14,15. The bridge’s procelain chipped and the bridge removed, in doing so ti was discovered 15 was decayed badly. So 15 was extracted (14 and 16 extracted 15 years ago) and temp crown put on 13. An oral surgeon did the extraction and the same day did a bone graft on 14 and 15. During this, the temp crown on 13 came off. It was cemented back on after the graft was done, same day. During the procedure, he said he noticed that there were bits of bone from 14 still in my gum and he said he tried to work them out but only an x-ray later on will tell.
    My questions are:
    1) Sutures go from behind 15 to 13. 13 ha two sutures, one before and one after it. Between the two sutures, on the inside of my mouth is a tiny speck white dot protruding from my gum (not the cheek side). Is this a piece of bone left possibly from 14 OR is it a piece of bone graft material working itself out through my gum?
    2) A mesh was placed over the graft site. When that is removed (probably in 4 weeks), is it possible that pieces of the graft material may still come out (as I read is normal)?

    • Ramsey Amin DDS says:

      Hi Chris,

      This all seems within the normal range. Without seeing you in person it is very difficult to try to asses this for you.

      Sorry.

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

  59. Bev says:

    I wanted to say thanks for this information. I was told Friday I needed an additional bone graft for #25……I’m happy to see sometimes this is needed, and this is the only website I have seen it on!

  60. Alisha says:

    Hello, five days ago, I had bone grafting and dental implant for teeth #7 and #10. They were baby teeth with no permanent teeth behind them. I have several questions.

    Question 1:
    The areas around the bone grafting and implant are still slightly swollen. I can see the silver-like screw in area #7, but I can’t see the scew in area #10. I have basically stayed on a liquid diet since having the procedure in fear the implants will come put. Because I can’t see the screw in area, does that mean it has come out, or could it be due to swelling? I go back to see my oral surgeon in two days to have my stitches removed. I was just hoping you could offer a small piece of mind until then. :)

    Question 2:
    A certified oral surgeon who specializes in this line of work performed the grafting and implant procedure; however, I was referred to my family dentist several weeks before the procedure to have impressions made for an Essix retainer to disguise the two missing teeth. The surgeon wrote “Essix Appliance” on a prescription tablet for me to take to my dentist. In turn, my dentist did NOT make the Essix. He instead made me a flipper. My oral surgeon advised against the flipper due to it may cause the implant to fail. He said Essix was better. I have an appointment withy dentist this afternoon to go over the correct piece: Essix. I am worried, however, and somewhat panicked (I have two missing front teeth!) that he will try to take new impressions and cause my implants to fail. Can the Essix be made with the same impressions molds I had done before the surgery? Also, I’ve been doing quite a bit of research on this, and I have read that an Essix can be difficult to get a perfect match. Is this true? I am worried because I need it to disguise the two missing teeth.

    Any info relating to these questions will be most helpful. Thank you!

    • Ramsey Amin DDS says:

      Hi Alisha,

      The fact that you can’t see the screw has no bearing at all. It is not an issue.

      An Essix temp is great but they are fragile. The impression can still be made for a new one even though the implants are already in.

      Everything you described sounds normal. Good luck.

      Dr. Amin.

  61. Caitlin says:

    Hi Dr. Amin,
    A week ago I had a bone graft on my front tooth, they also took some tissue from the roof of my mouth to build it up because I had very little gum tissue. The dentist said I wouldn’t be able to eat normally for another 5-6 weeks. All the stiches are out and it’s sore but I was looking forward to eating normally instead of applesauce and pudding. What foods would be okay to eat? What should I strictly avoid? Can I have sandwiches or pizza?
    Thanks!
    Caitlin

    • Ramsey Amin DDS says:

      Hi Caitlin,

      Avoiding pressure on a bone graft for dental implants is very important. Until you see your dentist, dont eat anything that you can’t squish with your fingers. Pasta, boiled chicken, soups, flaky fish, etc are all good choices.

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

  62. Lance Pearce says:

    Hello I’m writing in regards to a bone graft I received two weeks ago today. I’m 29 and received a root canal on tooth #30 when I was roughly 15. Recently I began to notice breakdown of the gum line around the tooth and would notice that infection would set in (the area would get red and raised) I went on antibiotics, finishing them up before going to the surgeon to get the root canal/tooth taken out. I was told that a dental implant would be the best option for me. In lieu of choosing the option of implant I was told I would initially need a bone graft. So I received the bone graft with the implant coming up probably within the year (have to gather the finances). Now that I’m two weeks out I’m still noticing minor issues such as moderate pain in the area, the tooth in front of it (another root canal tooth) and the molar behind it feeling “off” or even sensitive to particular things. But then again could it just be the graft area that I’m feeling? I’m aware that pain can be felt between teeth rather than at the source. What is the turn around time for healing, my greatest concern is the possible failure of the other teeth around it. I get a “floating” type feeling, or even a nagging (sorta of a throbbing) feeling at times when I bend over, become really active or even jump. Is this normal? That’s my chief concern, I also have noticed that coffee seems to have adverse affects on how my mouth is feeling. Any help would be great… last thing- the tooth was very infected and the surgeon had a very difficult time taking it out due to how broken down it was and had to actually cut away at the surrounding bone which caused the need for a bone graft. Is all that I’m feeling normal? This is the first bone graft I have ever had. Again I appreciate any help you could give.

    • Ramsey Amin DDS says:

      Hi Lance,

      What you are experiencing may not be normal. After about 1-4 weeks most grafted areas have no symptoms.

      It really sounds like you might have issues with the surrounding teeth. I would suggest you get them looked at ASAP.

      Without seeing you personally, it is difficult to tell you anymore.

      Sorry. I hope this helps you. Don’t give up!

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

  63. Nicole says:

    Three weeks after dental implant I have pus coming out of the area….I can’t see a dentist until tomorrow….what do I do in the meantime?

    • Ramsey Amin DDS says:

      Have the dental implant specialist call you in some antibiotics ASAP. This is a the reason I give my patients my cell number if they have any issues.

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

      • Brian says:

        Hello Dr. Ramsey. I know i have a serious form of periodontal disease around my right front top tooth. Both the front tooth and the one next to it are lose. my gums above my teeth used to be really red so i started brushing and using mouthwash. I can tell on gums that i can see have returned back to the normal pinkish tint, but my front tooth is not fully exposed on the visible side. and is extremely loose. I do believe it will need to be remove and a block bone graft put in its place to rebuild the bone and prep for a dental implant. Can you let me know if i am on the right path of my diagnosis and could you give an estimated cost with and without dental insurance. Thank you sir.

        • Brian says:

          I meant to say the tooth on the visible side is now fully exposed.

        • Ramsey Amin DDS says:

          Hi Brian,

          It is very difficult for me to guide you with such limited information. I would really need to see you and take some x-rays.
          Cost range is likely to be $3-7k.

          Respectfully,

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

          • Brian says:

            Thank you sir for responding to my question. i have done more research since my last post. The entire front wall of my tooth is gone all the way up. Can the tooth that is loose and still has plenty of bone be splinted to the one next to it so that the particulate bone will grow back new bone and stabilize the tooth? I do need to get the periodontitis under control first i know but after the front tooth is extracted about how long would you think i would need to wait to get a flipper for cosmetic appearances and when i could get the block bone graft? i just do not want to go more than a week without a missing tooth. That is my biggest fear.

          • Ramsey Amin DDS says:

            Hi Brian,

            I make flippers for patients on the very same day of the extraction so they never go without a tooth! There are other better options than a flipper such as an Essix. The temp is CRITICAL during a block graft!

            Respectfully,

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

  64. Edwin says:

    Good evening Dr Ramsey. I had a tooth pulled (lower right jaw) a week ago and the dentist put in a bone graft and stitched me up. In the last two days all my stitches have fallen out and I can see something in the hole that has a bunch of little dots. Is that the graft? And am I supposed to see that and/or should I contact my dentist? Thank you in advance.

  65. Brian says:

    Hello Dr. Amin. After viewing your video on block bone grafting. i can say that i will be needing one of these for my right upper front tooth. The entire outer aspect of the bone for that tooth is gone and the tooth can be pushed forward to the brink of falling out. The tooth to the right of this tooth is also very loose as well. Can the tooth that still has bone on the outer aspect be saved with other types of bone grafting? On the other front tooth. it moves some but is still strong but most of the ridge between both upper front teeth has receded. I will need scaling and root planing for my front lower teeth as well to eliminate the periodontitis infection that is down there as well. all of those teeth do not move. When someone has periodontitis, does the diesease have to be took care of before the block bone graft can take place? will i have to run around without a tooth and the bone graft until the disease is took care of? After the block bone graft, flap surgeries and whatever else i will need, how long can i expect to get a flipper to replace to the missing tooth? I know these are alot of questions but just so many concerns. Thank you for your time

    • Ramsey Amin DDS says:

      Hi Brian,

      The other loose teeth may tighten up after the gum treatment. You will have a temporary tooth during the bone graft. It generally takes 8-12 months to complete.

      Respectfully,

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

      • Brian says:

        Hello Dr. Amin. I have undergone a periodontist’s treatment plan. I took antibiotics to kill the underlying periodontal disease and have also had all 4 quadrants completed with root scaling and planing along with the laser treatment. I consulted with anothrer dentist to have a second opinion and she believes that since i have one tooth that has completely came out on its own because of the amount of bone loss, have another that is extremely lose do to bone loss and two others that have catagory 1 movement with slight bone loss that all four of my front teeth need to be removed and a double block bone graft be completed to place four implants for a four crown front bridge. My periodontist said that after my 6-week eval that will pull the teeth needed to be pulled and place with a flipper so i will not be leaving the office with out missing any teeth. When the time comes to perform the double block grafting, will i be able to use my partial denture or will it need to be adjusted so that it does not impact the surgical sites. Thank you SIr

        • Ramsey Amin DDS says:

          Hi Brian,

          Yes, you will be able to use the temp during healing. Keep in mind that if the temp rubs the gums during the first three weeks the stitches will open and expose the bone. This is not a good thing!

          Your dental implant surgeon will need to release the tissue for the block graft to fit. Why the block grafts though? Have you been given other alternatives such as bone expansion?

          I am not against block grafting, but there are many other less invasive methods that work so well. Sometime the block is the only way it is possible though.

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

          • Brian says:

            Hello Dr. Amin.

            My upper front right tooth has completely came out because the front wall is completely gone and the gums have grown into the socket which has casued the tooth to move forward and detach from periodontal ligament. My left two upper teeth do have some bone loss as well and move somewhat but do have alot of bone left. The general dentist recommends that all four front teeth be replaced with implants because there is no way to fill in the gaps where the gums have receeded and to make the single implant match the rest of my mouth. im just frustrated because i have had this going on the last 3 months and i am ready for the partial so that i can be comfortable smiling at people again and not have to worry about people staring at my teeth and asking me whats wrong. Was hoping the necxt visit would be a impression for the partial but it is only going to be a follow up of the root scaling and planning that was done. im ready to move on!

          • Ramsey Amin DDS says:

            Hi Brian,

            Based on what I hear I would probably agree that the other teeth would need to be extracted too.

            You should be able to have the implants done on the same day or 3-4 months after extraction.

            You should have a temporary the whole time ! You should never be without teeth during the dental implant process.

            It sounds like you and your dentist need to review your plan. There must be a reason for the delay.

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

  66. Hello, I had 3 impacted wisdom teeth last week, as well as a molar that never grew in all the way. they did a bone graft on the molar. I did not get an implant because ive never had a full tooth there any way. So that was 8 days ago, they did not prepare me for the severity of these procedures. After 4 hours AWAKE thru the procedure ( apparently they could not get the teeth out) I walked out in sever pain and the swelling was outrageous i looked like elephant man. They did say all teeth were extremely difficult to get out, but im still very swollen and the pain has gone down but still pretty intense. I can not talk without a serious slur, I can not chew, i can not open my mouth more than 1/4 inch , my cheeks still look like chipmunks and they are yellow…. Is this normal, im known for being a tough girl pain does’nt bother me much , but this seems a little over the top and its been 8 days they said it would go down by now.
    thank you for your time

    • Ramsey Amin DDS says:

      Hi Auberon,

      How are you doing now? Sorry for the delayed reply.

      Respectfully,

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

  67. Judith Baland says:

    I have implants in front lower jaw, with bone grafts. I am 66 years old. What can I do to help insure that these grafts will grow? Can I or should I take supplements. I take vitamin D daily . Should I take Strontium bone builder? Also I sleep in the temp teeth..they said I should keep this covered all the time..I have clenched my teeth most of my life should I let them know or wear some sort of drugstore appliance to protect the implants. I have two more months before I am scheduled to return to my dentist. Thanks You for any information. Your site has been helpful.

    • Ramsey Amin DDS says:

      Hi Judith,

      You should see your dentist for clarification. If the temp teeth are removable, I advise most people just the opposite…take the teeth out when you sleep.

      Clenching and grinding forces are detrimental to healing dental implants.

      If they are fixed temps, don’t chew anything solid on them.

      There are no special bone building supplements. Eat right, don’t smoke or drink, and maintain a good weight. These will prevent most health problems.

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

  68. David says:

    Is it possible to do a bone graft on a good tooth? I have lost bone around the gum line and is prone to infection.
    It is the last tooth upper left. My dentist would like to pull the tooth.
    I have had only one infection.

    • Ramsey Amin DDS says:

      Hi David,

      Not all natural teeth can be bone grafted. They have to have a certain pattern of bone loss to be able to be grafted predictably. I would have to see you to answer this.

      Dental implants and teeth follow
      different sets of rules for building bone.

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

  69. Saad Mahfuz Platini says:

    Dear Sir,
    If the donor bone is taken from jaw or chin area can this area be used again in future for furthur bone graft? For example, after several months when the donor site is healed could the bone from this healed area be taken again?

    If synthetic bone graft fails does it mean the patient can never have that kind of synthetic graft anymore?

    • Ramsey Amin DDS says:

      Hi Saad,

      Nothing is absolute. You can re-graft and re-harvest areas that have been used for donor bone graft sites. It is a bit more complex though. Better to have it done right the first time.

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

      • Saad Mahfuz Platini says:

        Dear Sir,
        Thanks for the reply. Actually several times it is seen that an implant might come out after few years. Also, bone grafting might need two tries when done first time. If the donor bone is already taken two or three times can it be furthur used after few years when the implant fails? I mean is there anything like a “number of times” a certain donor bone can be used or does it grow back to its original shape and form after sometime and can be reused over and over again.

        If synthetic or bovine graft fails does it mean the body has rejected the graft and that particular person can never have graft from these materials?
        Actually, I am very healthy. However, I am missing several teeth and I am pretty young. I read news like xenograft has 75% success rate. So, it worries me thinking that there are 25% people who cannot have bone graft.

        • Ramsey Amin DDS says:

          Hi Saad,

          It is not the bone that has a “75% success rate.” It is the technique, skill and expertise of the surgeon in placing the bone graft and your ability to heal. It sounds like you need someone more concentrated on implant dentistry to take over your treatment. You should also have a medical evaluation.

          Respectfully,

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

  70. Jordan says:

    Hello,

    I recently got a bone graft for a couple of implants and they say that I need to get some other work done before doing the implants. They told me that I would have about 1-2 years before the bone graft wouldn’t be strong enough to support the implants. Is this true? Is it true that there’s a time limit as to how long the bone graft is able to support the implant?

    • Ramsey Amin DDS says:

      Hi Jordan,

      Most bone grafts heal in 4 months. Some people need more than one graft if their situation is complex. Occasionally a complex graft will take 7-9 months, but those are uncommon.

      Respectfully,

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

  71. Bev says:

    Hi – me again. I had my other bone graft today. I asked what it was, and the nurse said it was coral?

    I have done nothing but read about bone grafts and have never seen coral. Is this a good thing or bad thing?

    • Ramsey Amin DDS says:

      Hi Bev,

      Coral is used for Hydroxyappetitie crystals. It does have some uses but is not as useful as others.
      The technique by your dental implant dentist is far more important than the graft or implant materials.

      Dr. Amin

      • bev says:

        Well, he is an oral surgeon who has passion for surgery in his eyes (funny how you can see that)….so I trust that he did it right, whatever right might be!

  72. Karl says:

    About 10 years ago as a child I had tooth 8 extracted and an an autologous and synthetic bone graft using Osteograf LD300 was placed. If there are no complications should this ‘site’ be ready for an implant or would more grafting needed?

    • Ramsey Amin DDS says:

      Hi Karl,

      The best way to know is to take a 3D scan of the area prior to implant placement. This way you can tell if the bone is still good or not.
      This link will help:

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

  73. Tiscali says:

    Hi. I just had a extraction and bovine bone graft yesterday. Today I am very weak and tired. I am 29 in good health. I was wondering how safe are these bone grafts when it comes to infections? Currently I am taking amoxicillin and I would like to make sure that I have nothing to worry about a possible infection. Thank you.

    • Ramsey Amin DDS says:

      Hi Tiscali,

      Bovine bone, which is cow bone, is safe and effective. Some bone banks are better than others and some have longer data. I use it all the time. You will do great! Infections due to bone type are uncommon. Infections due to technique or healing is relatively common.

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

  74. Kai says:

    Hello,

    I had a bone block on #9 about 5 weeks ago. I got my braces taken off 3 weeks after the bone block and have been wearing a retainer. I take the retainer out to eat and have been trying not to chew with my front teeth too much. About 5-6 days ago I noticed white chunk sticking out of my gum. It seems to be getting worse and after touching it with a probe I know it is the bone block exposed. There is just a little big exposed right now, but I am wondering if the block has failed? There is a little bit of pain, but not much and I don’t see signs of infection. Please help!

    • Ramsey Amin DDS says:

      Hi Kai,

      You need to see your dentist asap. Exposure of the block bone graft is never a good thing. Keep me posted. Make sure to reference this post when you do.

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

      • Kai says:

        Thanks for the post, my surgeon wants to wait it out to see if “mother nature” will take care of it. If not, he said he will grind down some of the block and stitch the gum shut. Will this still be successful, and will the block heal to do an implant? I am only 26 y/o so I need this implant to last a lifetime preferably.

  75. David says:

    I had a tooth extraction but root was still left in. Had to see an oral surgeon to remove the root. Infection was found and he cleaned it all out. Straumann Bone Ceramic graft was immediately put in straight after the extraction with a membrane placed after for preperation of implant. Six weeks later, it is still sore and quite painfull. Is the pain and soreness normal healing symtoms or a sign of returned infection?

    • David says:

      Also, no swelling. There is what looks like bits of bone working there way out.

    • Ramsey Amin DDS says:

      David,

      What you describe can and does occur but maybe in only 5% of socket bone grafting. How long and what type of antibiotics are you on?

      Respectfully,

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

  76. Beth says:

    Hi,

    Just over a week ago i had an accident where i fell forward onto my mouth hitting a hard object. #7 was pushed directly up into my gum and #8 was pushed back into my palate. I lost quite alot of bone, both teeth were extracted and i went in for surgery where i had bone graft put in place. My concern is that the area is still swollen (especially my palate) but i can see abit of membrane but it looks as if there is not enough gum to cover it. Is it safe for this membrane to be exposed, the dentist says it is healing well and doesnt seem concerned! Thanks.

    • Ramsey Amin DDS says:

      Hi Beth,

      Some membranes can remain exposed and are purposely done this way. Others require that it stay covered like when doing titanium mesh bone grafting:

      titanium mesh

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

  77. David says:

    I was given a course of 21 Metronidazole 200mg tablets. I finished taking them last week.

    • Ramsey Amin DDS says:

      HI David,

      Was anything else given with the Metronidazole at the same time? 200mg or 500mg? It is often grouped with another antibiotic at the same time

      Dr. Amin

  78. Olivia says:

    Hello, first of all thank you for this forum. I find your answers very helpful even if its not addressed to me. I had bone graft (sugar like cube placed in my jaw) a week ago. The procedure went well with no pain involved. I had swelling and pain afterwards which I handled with painkiller for a few days and antibiotics. Swelling was persistent or even growing for 4 days then it started to get smaller. A week has passed and I still have a little swelling in the area and very little pain if I move my mouth too much. The concerning issue is that I have some numbness on my face in graft area and I’m so scared that what if the doctors damaged some of the nerves in my jaw bone. Should the numbness last for weeks? Is it normal that I still have some numbness, strange sensation started from graft area till the chin? PS I needed bone grafting because my bone was too thin for implant. Im 29 and yes shame that I have several missing teeth already :(

    • Ramsey Amin DDS says:

      Hi Olivia,

      I assume you had a bone block graft on your lower jaw.??? Where was the bone taken from and where was it placed?

      Please copy and paste your original question with your reply so it is easy to follow.

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

  79. David says:

    It is now six weeks after surgery and stitches taken out. Can’t understand why I’m still getting soreness on a daily basis, which is worrying.

    • Ramsey Amin DDS says:

      Hi David,

      I assume you have seen the dentist for multiple post op appts and rounds of antibiotics? What you are experiencing is not totally normal but within the range of normal. Most of my patients have zero pain after one week.

      Respectfully,

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

      • David says:

        I was put on Metronidazole 200mg four weeks prior to the op.
        and as said took Metronidazole 200mg again but no other antibiotic. What would possibly happen if the symptoms continue and get worse?

  80. Olivia says:

    Yes it was my lover jaw. And I was told that bio-oss was used for my graft. My bone was not shrinking it was just too thin for immediate implant. That’s why he decided to thicken it. But I till have some numbness that worries me a lot. Done my surgery 9 days ago.

    Bellow is my previously asked question.

    I had bone graft (sugar like cube placed in my jaw) a week ago. The procedure went well with no pain involved. I had swelling and pain afterwards which I handled with painkiller for a few days and antibiotics. Swelling was persistent or even growing for 4 days then it started to get smaller. A week has passed and I still have a little swelling in the area and very little pain if I move my mouth too much. The concerning issue is that I have some numbness on my face in graft area and I’m so scared that what if the doctors damaged some of the nerves in my jaw bone. Should the numbness last for weeks? Is it normal that I still have some numbness, strange sensation started from graft area till the chin? PS I needed bone grafting because my bone was too thin for implant. Im 29 and yes shame that I have several missing teeth already.

    • Ramsey Amin DDS says:

      Hi Olivia,

      At nine days you are still within range for your sensation to return back to normal. Keep in close contact with your dentist and make sure he/she is aware of this.

      :) Dr. Amin

  81. Meliss says:

    I had an extraction and bone graft on tooth #31 on 3/15/13. Just wondering if it is normal to still be experiencing pain on a pretty regular basis?

    While I regularly experience a low pain tolerance, it is not usual for me to use all of a prescription pain medication for any dental procedure.

    I have been on a soft diet since the graft, using ice several times a day and limiting my activities when the pain becomes intolerable. I have noticed some swelling in the mornings but I clench my teeth at night and thought that may have something to do with it.

    The pain is a throbbing that comes and goes throughout the day and is worse if I bend or kneel. I am currently taking ibuprofen, amoxicillin and a non-narcotic pain medication. Is it customary to need additional pain medication after one week.

    I’m usually a trooper with no complications. Just a little discouraged. Any advise would be greatly appreciated. Many thanks in advance!

    • Ramsey Amin DDS says:

      Hi Meliss,

      I may not understand your question. You said the graft was done in March, but later said it has only been a week. Can you clarify this? If it is only a week, this would be within the range of normal.

      Some bone grafts I do are HUGE and others are tiny. The bigger grafts tend to have more post op pain. The technique is critical and so is your ability to heal.

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

  82. Monica says:

    Dear Dr. Amin,

    I had tooth number 19 extracted on May 20 and a bone graft. My tooth was infected for close to 3 weeks before that and infected during the extraction but cleaned out. Previously, a dentist also tried to do a root canal on my tooth on May 16 but if failed, hence the reason for the extraction in addition to a tooth eating bacteria that had left open wounds on my tooth and eaten up parts of my tooth. (The dentist showed me the photos of the described above taken during the failed root canal). I have been on 3 cures of antibiotics since May 4: Amoxicillin and almost two cures of Penicillin, which I had to stop today since I developed an allergic reaction to it. Overall I finished 69 pills of penicillin/amoxicillin. I have also been taking Vicodin, Ketorolac and 800mg Ibuprofin and Motrin. The pain medications barely work, however.

    My question is, is it normal to still have pain from the surgery, now 10 days later? The pain still requires pain pain medication every 5-6 hours. The pain is pounding in my extracted tooth area, jawbone, inside my cheek, throat and up towards my ear. My face is still slightly swollen (10% swollen) and my throat feels sore and a bit swollen. I also have a bad taste in my mouth and a bad smell. I have been following post ops routine of warm saltwater rinses, dentist mouth water rinses, brushing with soft brush and flossing and not eating close to the tooth area. I do not smoke.

    Thank you for your reply.

    • Ramsey Amin DDS says:

      Hi Monica,

      I already answered your question on your second follow question. Hopefully you see the response and I hope you feel better!

      Intravenous and intramuscular corticosteroids would have helped prevent a lot of your problems. I do a ton of these over the last 14 years and rarely ever have patients on pain meds after 2 days.

      Very respectfully,

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

  83. Olivia says:

    I’m getting back to normal 4 weeks later after the block bone graft done on my lower jaw bone. Swelling is gone and no more pain. Thank God! Bless good doctors!!! My question is about resorption of bio oss bone graft. On my face (right side) bone graft area is a little visible. It looks slightly bigger than before. And I really love to have symmetric face features. But I can feel some lumpiness under my skin. It’s not swelling but block bone graft that make it look like that. So I hope that the graft will be resorpted slightly. my doctor said it will slowly get smaller for about 30 %. In your experience, what percentage of the block graft will be resorpted?

    Olivia

    • Ramsey Amin DDS says:

      Hi Olivia,

      30% is within range. I typically see about 10-20% shrinkage so I do overbuild with that in mind. The graft should not be exposed. Bio-Oss is cow bone.

      Severe pain is NOT common after even block bone grafting unless the graft is massive or you have a unique medical history.

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

  84. Monica says:

    Hi again Dr.Amin,

    I am just writing to you again regarding the above question. I am still in pain and still need pain medications from the tooth extraction and bonegraft done on May 20. Is this normal to have still have pretty severe pain 15 days after the surgery? The pain is a 6 on a 1-10 scale.

    Thanks,
    Monica

    • Ramsey Amin DDS says:

      Hi Monica,
      After 15 days you should be on the mend unless it was a massive graft. Massive would be at least a 6 tooth section of teeth.
      You should have seen your dental implant dentist twice by now.

      Respectfully,

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

  85. Monica says:

    Dear Dr. Amin,

    The graft was only for one tooth (# 19) and I did see the dentist on day 16 after the surgery and he gave me more antibiotics (Clindamycin) and Oxycodone as pain was getting a lot more severe, and he told me to do rinse the extracted area with oral rinse and put a heat pack on my chin. I am now on round 4 of antiobiotics/penicillin. Pain level is now around 2-3 (on a 1-10 scale) and it stays around there as long as I take antiibiotics and hydrocodone.

    I don’t understand why I still have pain 19 days after the extraction/bone graft of one tooth? Is this normal? What would be an explanation to the pain? Dentist said I have to see him in a few more days but no explanation to what is going on so I am very concerned.

    Thanks,
    Monica

    • Ramsey Amin DDS says:

      Hi Monica,

      I would really have to see you at this point to be able to help. You might be a slow healer for a number of reasons.

      Even though it is not common to have 19 days of pain, you may be on the far end of the bell curve of normal surgical healing.

      Dr. Amin.

  86. Natasha says:

    Hello. Two weeks ago I had a bone graft done on number 7. I had a root canal on that tooth a while back and recently it developed an infection. I went to an endodontics and he said that the tooth does not need to be remove. He said that the he will perform surgery in which he will cut the part of the root of the tooth out and replace it with a bone graft. A few days after the procedure my face swell a lot and my endodontist said that it is normal. It has been two weeks now and the swelling has to e down a lot however I can still feel it being swollen around the area that he worked on. How long does it take for the swelling to go away completly. The dentist also prescribed me amoxicillin for five days after the procedure which I took as directed. Thank you.

    • Ramsey Amin DDS says:

      Hi Natasha,

      Your degree of swelling has a lot to do with the difficulty of the surgery. It also depends on whether you received corticosteroids and or NSAIDs via the IV or IM route.

      Hopefully you recover quickly. Give it some time. Let me know if you need anything.

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

  87. Hemans Daniel says:

    Hello Dr. Amin. I have a serious problem with one front tooth in the upper jaw. Its complete gone. Its about to fall off. I went to see an implant specialist who said that an implant is impossible because I have no bone left in that area of the tooth.

    He suggest extracting the offending tooth together with the one before and the one after and place an “implant bridge”. I am really concerned with this, because I cant understand why I have to destroy two good teeth in order to correct the bad one! He said he would not recomend a bridge, because he is concerned with the two sourranding teeth.

    Yesterday I decided to get a second opinion and was told all I needed is a bridge. But having a bridge is also destroying two good teeth!!

    So my question is…Wouldnt bone grafting enable me to grow bone for a single implant?

    • Ramsey Amin DDS says:

      Hi Hemans,

      It sounds like the the teeth on either side of the proposed dental implant have bone loss. If this is the case, those teeth will greatly affect the implant, especially from a cosmetic standpoint. This is a bad situation if you show a lot of gums when you smile.

      This link should help you understand;
      http://www.burbankdentalimplants.com/the-triangle-of-gums-between-teeth-and-implants/

      If you bridge the two weak teeth together, you are also likely to have problems.

      Get yourself a third and final opinion with a well credentialed implant dentist.

      Good luck!

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

  88. Ana says:

    What a fantastic site and incredibly generous doctor you are for replying to people. It’s so rare. Thank you so much!!!
    I had upper central right root canal a couple of years ago. It finally broke. No crown was offered at the time. So it cracked to a point an implant will be needed.
    One of the clinics I saw said I will need a block bone graft. Is this common? As the tooth is still in my mouth and has been temporarily bonded to the teeth next to it so I can decide what to do. I thought a block graft is for quite a bit of lost bone how can that be for me. I understand all cases are different.

    So now I am going to see a specialist and will be trying to get my scans from the clinic so I don’t have to do them again.
    Before all this I will need some gum treatment as my gums need to be in better health. Long story behind that
    Again thank you SO much. And if there any possibility for you to take a look at my scans? I don’t like in America but would be willing to email them to you

    Really hope to hear from you soon

    • Ramsey Amin DDS says:

      Hi Ana,

      Consider grafting the socket of the tooth when it is extracted.

      This link will help:
      http://www.burbankdentalimplants.com/extraction-socket-bone-graft/

      If there is any outer bone wall it may reduce the chance for a larger second block bone graft. You may achieve a good result with 2 smaller bone grafts rather than one large one.

      I would suggest you take another 3D scan after the tooth is removed and grafted. Wait 4-6 months before the second scan.

      Good luck!

      Dr. Amin :)

  89. Hodeah Duncan says:

    Dear Dr. Amin,

    I’m currently in South Korea and while I’m here I decided to get some dental work done. I have had several procedures done including an implant on my lower left side. I have two and a half months left here and was told by my dentist that it is possible for me to have another implant and bone graft done and it would be ready to have a tooth placed on it before I leave. Is that even possible?

    • Ramsey Amin DDS says:

      Hi Hodeah,

      Yes it is possible to have an implant done that quickly. Even though it is possible, a single dental implant that is going to be ready for its crown that quickly will need to have:

      High bone density…usually found in the front teeth areas

      High initial torque.

      Favorable bite pattern

      These are just a few critical items. I tell my patients not to race through getting your teeth. But if it is safe and predictable, I am all for it.

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

  90. Jennifer says:

    Hi Dr Amin,

    I just had #8 removed with a bone graft due to breakage 6 years post root canal. I have bone graft material come out every day, it is black in color and has a foul odor. Is it possible that not all of the decay was removed prior to placing the graft? The decay into my jaw was fairly extensive. I was on Cipro post procedure and I do have a very rare auto-immune disorder called job syndrome. I have an appointment with the surgeon for follow up on the 11th..Should I try to get in sooner?

    • Ramsey Amin DDS says:

      Hi Jennifer,

      For the benefit of the blog readers: Job syndrome is a condition that affects several body systems, particularly the immune system. Recurrent infections are common in people with this condition. Dental abnormalities are also characteristic of this condition. The primary (baby) teeth do not fall out at the usual time during childhood, but are retained as the adult teeth grow in.

      Most rare syndrome patients are best treated by residents and faculty within a dental school in a large city. They have significant resources to keep you safe and determine whether you should have dental implants. They work closely with the affiliated hospitals too. You may want to consult an infectious disease expert also.

      Good luck and keep me posted.

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

      • Jennifer says:

        I am seeing an immunologist and pulmonary doc. I hadn’t even considered an infectious disease Dr. I currently do not have insurance and I’m doing this all out of pocket. Thank you so very much for the reply and I will definitely keep you posted with my progress. The graft for me wasn’t so much for implants but to try to mitigate bone loss.

      • Sandy Stauffer says:

        Hi Dr. Amin,
        Beginning about 3 years ago, I began the process for dental implants across my entire upper jaw. I am 50 years old now and have had root canals in every tooth except the bottom 6 in the middle front. My first began at age 17.
        I first started with the top middle 6 teeth and have had no problems. Then I went on to my upper right where they did the removal of teeth and the bone graphing along with a sinus lift. I waited 4-5 months and received the implants and again had no problems. Last November I had my upper left jaw done with the same sinus lift, graphing, etc. A few days after surgery I developed a severe infection where the oral surgeon had to remove and fully clean the site. I waited 8 months to have the procedure done again on June 24th. I started an antibiotic, (Keflex), a couple days prior to surgery. So I had the sinus lift along with the graphing done again. About 2 weeks after the surgery I developed another infection and severe swelling, foul odor, puss running out the nose and in the mouth. This time I had no pain except for soreness when I pushed on my cheek. I took more Keflex for a week and I still have puss and odor. He tried a new Rx called Amoxicillin and Clavulanate, 1000mg/62.5
        He is worried that I may need the graphing removed and infection drained. He seems baffled as to why this keeps happening. He had said it had been many years since a patient formed this type of infection from his graphing procedure.
        I may have to go through this again in months. Do you have any idea why I would be getting these infections?

        • Ramsey Amin DDS says:

          Hi Sandy,

          Did you have a 3D X-ray taken before the sinus graft? Was there any problems seen? Do you have any immune system issues? It sounds like your dentist is experienced enough.

          If you where a removable temp over the graft that is likely the issue. They rub and open the stitches if worn too early.

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

  91. Chris says:

    Can a dental implant push bone or bone grafted material outside of the gum? I had a bone graft done on 14 and 15 seven months ago. All felt fine. Now I had dental implants put into 14 and 15. The gum on the outside of 15, toward the cheek hurt a bit. I finally can open my mouth wide enough to see that there is a white spot on the outside upper part of 15. Could it be that the implant in 15 pushed some bone out of the way and toward the side, outside the gum against the cheek. The area is sensitive if I open my mouth wide or to the direct touch? If it is bone that was pushed, what can be done for it?

    • Ramsey Amin DDS says:

      Hi Chris,

      Get in to see your dental implant dentist soon. Sometimes particle types of bone grafting material can sequester out of the bone a few months later. It may only be a tiny speck which is usually no cause for alarm.

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

  92. Alma Sharp says:

    Dr. Amin: Thank you for your selflessness in answering all of these questions on the awesome website.
    One week ago I had a full mouth extraction in preparation for dentures. I had some pretty severe bone loss (yes I had taken Fosomax) and had been put on Clindomycin for 10 days prior due to abcess on left lower side of 3 teeth that were quite loose. During the extractions of the upper teeth my left “eye tooth” gave me pain up into my hairline. It was also found that I had to have bilateral Open Sinus Lift Procedures as well. My question is, I am still in so much pain and pressure in my upper front gums and sinus areas into my eyes that I am still having to take Vicodan 5/500 q6h. Is it normal to still have this much pain after 1 week? I did have swelling, but that is subsiding and the bruising is to the yellow stages now. I am finishing another round of Clindomyacin tomorrow. I do have inflammatory arthritis and fibromyalgia with a couple other autoimmune issues. Do you think this has anything to do with the continued pain?
    Thank you in advance for your opinion.

    • Ramsey Amin DDS says:

      Hi Alma,

      Thank you for your kind words.

      It sounds like you had several procedures all done together in conjunction with many extractions. Considering the magnitude of your surgery, you are probably within the range of normal. I am hoping you had IV sedation and intravenous and or intramuscular steroids to reduce the post op swelling. Apply heat to the bruised areas and try to get off the vicodin asap. Most of my patients who undergo MASSIVE grafting may need vicodin or toradol for 3 days then move on to over the counter meds. Be sure to see your dental implant dentist asap in case. Some bone graft additives cause major swelling too.
      I prefer PRP.

      Heal up!

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

  93. Alma Sharp says:

    Dr. Amin, thank you so much for your speedy response. I feel better now knowing that you feel I am in the normal range. I had not sedation except for .5mg Xanax prior to sx and was given Novacaine for the procedures. I will try the heat for the swelling I still feel. Again thank you for caring and responding.
    Have a great evening.
    Alma

  94. Arlene Underwood says:

    Hi Dr.
    I lost one of my front upper tooth in an accident about 12 years ago and was wearing a flipper denture until recently. My jaw or gum was inverted due to how i had lost my tooth and also from wearing the flipper for so long. I was advised to get a bone graft first before the implant and crown. I got the bone graft done last wednesday the 17th of july and got a temporary crown placed in yesterday. The dentist has told me I will go in for the implant on the 24th of October and if all is well and healed with the bone graft i will be able to get the implant placed in. Do you think my bone graft will be healed by then, exactly 3 months after the bone graft was placed in?

    • Ramsey Amin DDS says:

      Hi Arlene,

      The healing time of the graft will vary based on the size and location of the graft in addition to many other factors. If anything, it is better to let a bone graft heal longer than shorter.

      Your experienced dental implant dentist will understand this. There are some grafts that I allow to heal for 9 months and others that I do on the same day the implants are placed.

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

  95. Beth says:

    Hi,
    I was just curious, if a patient has had a block bone graft in preparation for dental implants, can further bone graft material be added 3 months later during the dental implant surgery.
    Many Thanks

    • Ramsey Amin DDS says:

      Hi Beth,

      Yes…this is quite common. I often add PRP or PRF at the time of the surgery to make you heal better.

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

  96. Aleida says:

    Hello Dr. Amin,

    On the 26th of July I had four wisdom teeth taken out. While my doctor was going over my x-ray of my teeth he informed me that I had a tooth that was growing inside of my gum. This tooth is located on my bottom right side of my mouth. My doctor did inform me that he was going to go in through my gum line, fold my gum over, take the extra tooth out, and stich me up on the sides of my teeth. There are four teeth where he stiched them on the side. He recommended a bone graph. I went ahead with the graph although he did also inform me that bone may possibly gradually form on its own. Today I noticed the area of bone graph is very swollen like if I have dip in my mouth. None of the stiches have dissolved, not even from my wisdom teeth removal. I did notice that in the area of the bone graph, my gum is apart from my teeth, like my gum is not attached to my teeth. I am not to sure if the area is still a little numb but when I smile, that side of the cheek does feel a little weird to me but when I pinch my cheek I can feel it. When I push down on the swollen bone graph a lot of blood started gushing out, and I did notice maybe a little bit of puss because it was swirls of white and red. I do not have a bad taste in my mouth or bad breath that I have noticed and I have been faithful with my antibiotic medication (4 a day) and proper care, from what I believe. I will be calling my doctor tomorrow morning. I am worried. I also do not feel the need to take my pain medication because the pain is berable. Will he possibly have to put me down again and open it back up? I am assuming this may be an infection? What do you think is going on and what will the procedure be to fix it/healing time? Thank you so much in advance. Sorry for the long comment.

  97. Aleida says:

    Also, now that I think about it, I started to spray salt water on my wisdom area two days ago. I do not think this is what may have triggered my problem because its just water with salt, but, could it be a possibility? I am hoping that my doctor will be at my dentist tomorrow since he is a traveling doctor. I am so worried and do not want this to Hirt or impact my other teeth. If so, will I have to get an implant? Thank you again.

    • Ramsey Amin DDS says:

      Hi Aleida,

      I am not a big fan of having invasive procedures done by a doctor that travels from office to office. It leaves you with no one to see.

      Most wisdom teeth do not need bone grafts. Unless you are 35 years or older and/or you have bone loss on your second molars, I don’t see much value to bone grafting these areas. They heal on there own. The graft slows it down. I don’t know your exact situation though.

      How is it now?

  98. Ryan says:

    I was just wanting to know a couple things. My #19 tooth fused to the bone and barely breached the gums years ago when I lost the molar. I went through a few years of orthodontic work to try to pull the tooth up but to no avail. At first I had a band on the back molar and a bracket on #20 and 21 with a tie to the low-sitting molar to try to pull it up. The other teeth ended up being pulled down. To fix this, I got a full set of braces and was left with a coil to keep the gap open in preparation to excise the low tooth. Well I got the tooth excised at the same time as my wisdom teeth. My doctor cut the tooth out but had to fill the void caused by the tooth (which I was told was about 85% of the way through my jaw bone) with grafting material and in about 4 months, we plan to put an implant and finally allow the other teeth to shift and close in on my “fixed” tooth. The wisdom teeth have healed beautifully. Almost completely healed within the first two weeks. I am concerned about the graft. I was told to be very careful to avoid any of the material coming out. Over the past few days, I have been getting small hard white granules. Only a small number come out a day (maybe 5-7). They are hard to the touch but when bitten (by accident) they become a powder instantly and effortlessly. I am now 15 days out of surgery and on my first week checkup was told everything looked great but this has started since then. Is this something to be concerned about? Should I call my oral surgeon and request an urgent follow up? Will this mess my jaw up even further?

    • Ramsey Amin DDS says:

      Hi Ryan,

      It sounds like you are healing normally. Teeth that are fused to the bone are always more difficult to remove and graft. Hang in there. You are doing the right thing by replacing it with a dental implant.

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

  99. Nikki says:

    Hi! This forum is extremely helpful and I appreciate your time.
    My questionis this… I am having bone generating/bone grafts and a sinus lift on the upper right for 2 implants. I am extremely worried about the pain afterwards. They prescribed hydrocodone 7.5? That has never helped but I don’t know what to ask for that is stronger. The 10 doesn’t work either. Any suggestions?

    • Ramsey Amin DDS says:

      Hi Nikki,

      I guess my techniques really are quite different than the vast majority of dentists doing this.

      I rarely have a patient that needs anything beyond Motrin 800 and Tylenol combined. I will give Vicodin as a back up but most of my patients over the last 14 years of doing this don’t end up using it! Iv sedation will help especially if steroids and IV NSAIDs are given.
      Great surgical technique and your great immune system make a great combo.
      Toradol may work for you.

      Keep me posted or come see me in Burbank!
      ;)

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

  100. Kimberly says:

    Hi Dr. Amin, I had a ridge augmentation and bone graft for the absence of tooth number 31 I went about 6 years before knowing that you NEED and implant asap when you lose a tooth, otherwise the gum line and etc.in that area will begin to wear away. They pulled teeth numbers 32 and 17 to help with overcrowding before I got braces; since there was no tooth behind number 31 the area has become more of a challenge to fix. My periodontist said there is a significant amount of bone loss from the absence of tooth number 31; because of this, there is a chance that I will need additional bone grafts after this one is done healing (they probably should have done a bone block graft?). I had both procedures (ridge augmentation and bone graft) in late March of this year. About 2 weeks ago they had to removed the titanium mesh due to infection the area was rising from slight swelling, and would recede back down a bit. They had me take penicillin for a week or so directly after the surgery in March, this time, when they removed the titanium mesh, I was told that I wouldn’t have to take any antibiotics. I’m concerned that the area has somehow gotten infected again, there is slight swelling and receding of the area. I know that the periodontist who did the procedure did not check the donor bone particle to see if it matched my bone marrow type. He mixed the donated cadaver bone with some of my own plasma or blood, and some synthetic particles. Do you usually have people use donated cadaver bone that matches their bone marrow type? Is there a high chance of infection when you use cadaver bone instead of the patients own bone? I’m concerned that the titanium mesh may not have been the infection issue, and that the cadaver bone they used for me is now being rejected by my body, and is the main source of the infection. P.S.- I brush twice a day and floss, I assume it’s not an infection from food particles being trapped in the area.

    Thank you for your help,

    Kimberly

    • Ramsey Amin DDS says:

      Hi Kimberly,

      It is often better to build bone in smaller stages when there is a lot missing. Two to three grafts are sometimes needed! The bone graft material is not a live transplant so you don’t need to check your blood type. It has nothing to do with the failure.

      Here is some info on titanium mesh bone grafting for dental implants.

      titanium mesh

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

  101. Joe says:

    Hello Dr. Amin
    I had an extraction and implant done with bone graft on tooth #19 2 days ago. This was all done at the same time. Post-Op I’ve had some trouble getting the bleeding under control as it’s only now beginning to subside. However what I’m most concerned about is the feeling I’m experiencing inside the mouth at the implant site. It feels as if there is gauze or cotton stuffed down between the inside of my cheek and my gums right where the stitching is. When I open my mouth, you can see it protrude on the outside of my lower cheek. I’m really not sure if this is swelling of the gums and is normal or if something may have gone wrong with the procedure. For example perhaps the bone graft was overfilled or the implant size was wrong. I’d really appreciate your thoughts on what might be going on.
    Many Thanks

    • Ramsey Amin DDS says:

      Hi Joe,

      It is hard to make out by your description. It might be a membrane that is exposed.

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

  102. Diana says:

    I had a bone graft done on my right lower jaw two weeks ago. The doctor added 3 cm of human bone in granules. The doctor removed the stiches after 9 days and the gum did not close. He cleaned it and put me on antibiotics for another week to prevent infection. I am scheduled to go back in 4 days and it is when the doctor will tell me what happens next depending on what the gum looks like. I am very concerned and I would like to know why my gum did not close and what the best course of action is. The doctor said the margins of the wound look necrosed and it may be because of poor blood circulation in the area. I am afraid the truth is he did not put the stitches right…I appreciate any input on this. Thank you.

    • Ramsey Amin DDS says:

      Hi Diana,

      Without seeing the opening in your gums showing the dental bone graft, it is impossible for me to asses via the blog. Tension on the flap, a removable denture, diabetes, osteoporosis meds, smoking, poor surgical technique are just a few of the many reasons this can happen.

      Good luck. You will heal!!

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

  103. Carol says:

    I had a successful implant on #7 eleven/twelve years ago with bone graft. Today, it felt like there was some food lodged between 6 and 7 that dental floss wouldn’t get out. I got a mirror and saw a tiny white fleck further up the gum. I scratched it and it came out and I believe it was a little bit of bone. Is it okay that one little bit of the bone graft would be coming out after all these years when I have had no other problems with the tooth? My oral surgeon has retired. My regular dentist does special xrays on this tooth and has always said it’s okay.

    • Ramsey Amin DDS says:

      Hi Carol,

      It is likely ok. It probably was a bone graft particle that never incorporated into the bone and was just stuck under the gums.

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

  104. Laura LeBlanc says:

    Hi Dr Amin,I had extraction and bonegraph tooth #30 2 months ago,I have had a funny salty tast on and off the since 1 week post op,was told no infection,but can still see the white bone graph material in center of tooth socket,doctor said he over filled it and I may lose some and it will close up,is it normal to still see bone graph in center 2 months post op?Thank you,Laura

  105. Laura LeBlanc says:

    Hi Dr.Amin,Two months post op,my oral surgeon took out the bone graph that was showing in the center of socket,he said he overfilled it,will there still be enough for it to work,he is very quick with me answering my questions.Thank you Laura

    • Ramsey Amin DDS says:

      Hi Laura,

      What you describe is not uncommon and should not affect your ability to have the dental implant.

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

  106. Olivia says:

    Hi. I had block bone graft 4 month ago on my law jaw bone for future implants as I had too thin jaw bone.. Doctor put extra large bone (bio oss) saying that some of its volume will shrink. 4 month passed and I still have a little bit of bulkiness on my face. I love to have symmetric facial features and that bulkiness really annoys me even though there is small difference. My first question is how i can resolve it and get rid of my bulkiness on the face? Also do you know how long the risk of block bone failure last? Can I say I’m safe because 4 month passed already?

  107. Sylvia says:

    I just had #10 tooth removed and a bone graft due to a car accident 3 weeks ago. This was done Thursday the 3rd, and today I noticed that there was something white an my stitches were kindof pushed out of the way maybe, is it possible that some of the graft is coming out? Is this bad or normal? It doesn’t hurt, just the normal soreness from having something like this done but no extra pain I didn’t even know til I went to look at my stitches? Should I be concerned?

  108. Hanna says:

    Dear Dr. Admin,
    I am having bone grafts and a sinus lift on the upper right for 2 implants and upper left for another 2 implants. The surgery was successful. Healing is very good. The problem started 10 days after as I started getting very bad smell pus draining out of my right nostril. I had no pain, no fever, no strange feelings. Nothing at all except the smell. My doctor gave me Augmentin 625mg for 7 days, and there were some improvements. When I finished the course of antibiotic treatment, the stink smell came back. Now, I am very worry about this condition, and I really need your expert advice on this. What do you think the cause of this? And how to cure this? And how long will it take to get back to normal?
    Thank you very much for your support.

    • Ramsey Amin DDS says:

      Hi Hanna,

      Change antibiotics or add a second antibiotic such as flagyl. Dental implant bone grafting can become infected at times. Are you a diabetic or a smoker?

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

  109. Lisa says:

    Hello! Almost two weeks ago, I had my #8 tooth removed due to a cracked root and infection, and an implant placed. I also had a bone graft and tissue regeneration. The doctor said that I had a very large “hole” near the roof of my mouth (because of the infection) and they had to use a lot of material to fill it in. the sutures are out now and the incisions are healed, but I have a large lump in the middle of the roof of my mouth. It feels spongy and sensitive. At my one week check, the tech said that they had to use a lot of material because the body absorbs some of it and the rest will replace the missing bone.
    How long will it take this “lump” to go away? I cannot use the flipper provided at this one, and the temp they made me is a bit annoying. I paid for the flipper, and I am concerned that the anatomy of my pallette will make it impossible to wear.
    Thank you!

    • Ramsey Amin DDS says:

      Hi Lisa,

      The lump should shrink over the next few months. Have an Essix temp made instead. It doesn’t go over your palate and will better protect your bone graft and dental implant. The pressure of the flipper is very likely to cause a problem.

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

  110. Kirsten says:

    Hello!
    I recently had a bone graft done on my two lateral incisors. (7,10) back in September. I healed very normally and am going back to see my surgeon to schedule the next operation in January. I just looked at my gum where they were placed and I can see the screws through my gums. Is this normal? How do I fix this? I made an appointment to see my surgeon this week because I am concerned. Thanks!

    • Ramsey Amin DDS says:

      Hi Kirsten,

      Sometimes you can see the bone graft fixation screws through the gum. Your gums are probably on the thin side. This should cause you zero worry.

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

  111. Paul says:

    Hello Dr. Amin,

    So nice of you to host this Q&A site for dental implant patients! I’m impressed that you’ve been at it for nearly 3 years now. Thanks!

    My question concerns exposure of a resorbable membrane after grafting with cadaver bone. I’m on my second graft in the area of #30 and #31, which were extracted. First graft was also cadaver bone, but with a titanium membrane that was removed several weeks later. The first graft was sutured nicely with no exposure of the membrane. Four months passed and I was ready to have 2 implants put in my lower jaw. Unfortunately, the graft had only partially taken, and my surgeon scraped out the spongy bone and did another graft. Two weeks have passed and the sutures have been removed and the swelling and pain have subsided. But it seems like quite a bit of the membrane is exposed—maybe an area 3/8 inch by 1/4 inch. Is this normal? And will the gum ever grow over the exposed area?

    • Ramsey Amin DDS says:

      Hello Paul,

      Yes I have been doing this blog since 2009. I really enjoy it, but sometimes there are more comments than I can reply to! Sorry!

      It is always better if the membrane is not exposed. Sometimes membranes will be purposely left exposed such as socket grafting or two-stage bone widening. It is always better if it can be avoided but it is not always possible. If an outer wall of bone is trying to be developed, membrane exposure can be catastrophic to the graft.

      Titanium reinforced non-resorbable membranes can sometimes be exposed and kept clean and still end up yielding good bone underneath. It is really case-by-case. One of the biggest problems is wearing a removable temporary on top of the bone grafted sites which rubs on top of the membrane. This almost always causes exposure of the membrane and bone graft.

      If you do wear a removable temporary try to leave it out as much as possible. Keep the area very clean by using Peridex on a Q-tip at least 3 times a day on the exposed membrane. It is never worth re-suturing the area has that never works.

      If there is enough bone, go ahead and place the implants and use mineralized cow bone at the same time to fill in any voids or soft spots that the first graft didn’t fill. Bone graft can be done at the same time as the dental implants themselves.

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

  112. Marty Powers says:

    I’m 5 weeks past the extraction and bone graft on one of the small bottom teeth. Everything appears to be normal, but a question. When I brush (I use a Sonicare, but am careful not to let it touch the missing tooth site) perhaps 5 to 10 VERY VERY fine particles show up in the sink, they aren’t gritty and almost microscopic. I don’t think they are from the tooth paste, but I was wondering what they might be and should I be concerned. Thanks !!

    • Ramsey Amin DDS says:

      this should help you!! It all sounds pretty normal.

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

  113. Sarah says:

    I had an extraction and bone graft done on #8. Everything healed up well. Then I had the implant placed at 4 months. Everything seemed to be going well, until one month later when I started getting pain and pressure around the area. No infection was present, and we waited another month to see what would happen. The dentist couldn’t find anything wrong on the x-rays, but he removed the implant because it appeared that it wasn’t osseointegrating. I had another bone graft done in the cavity. That was one week ago. In the morning I still feel some pressure, and it gradually builds throughout the day. At night it feels very painful. I am wondering if my body is rejecting this bone graft as well, even though the original one I had done last summer went well. I have eaten well, do not smoke, and have taken vitamins and minerals to help the bone grow. I was trying to wear my flipper after day 3, but it hurts half way through the day and I take it out. Could it be causing the bone graft to fail? If I am still feeling this pain at 7 days, should I wait it out longer, or assume that it’s already too late? What is the next step…. another bone graft? It was going so well in the beginning….
    Any insight or advice is appreciated!

    • Ramsey Amin DDS says:

      Hello Sarah,
      He need to see your dentist ASAP. The flipper can definitely be causing all of this. It should be placing 0 pressure on the bone graft and in fact should not be touching it whatsoever. Did you have an onlay block bone graft with fixation screws? Or did you have a particulate socket graft? Was the outer wall of your bone reconstructed?

      The more major the bone graft, the more important it is to not wear the flipper and that it is drilled completely clear of the bone graft for the first month. Also what we call tension-free closure of the site is really important.

      You should be checked out by a medical doctor for any underlying medical condition that could cause bone graft failure such as diabetes, liver, kidney, parathyroid gland diseases

      Keep me posted,

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

      • Sarah says:

        Thank you Dr. Amin for your response. I had a particulate graft in the cavity left by the implant after it was removed. Today I left the flipper off completely and it doesn’t feel as bad, although I still feel some pressure. I am trying to be very careful. I will update you after I see my dentist in a few days. I hope it is not too late for this graft.

        • Sarah says:

          Dr. Amin,

          I had my appointment today and the dentist took out the suture. Over the past weekend, they gave me a stronger antibiotic when I phoned them about the pain. I started to feel better, and no longer needed pain medication at night, so it must have been an infection that began after I had the implant placed. I still have some tenderness up in the area under my nose, and sometimes across the front. Occasionally I get a weird shooting pressure sensation in the area of the graft. The dentist said that he sees no infection, and that it is normal to have tenderness while the bone is healing. He checked the fit of my flipper and said it is not putting pressure on the area, but I am still leaving it off as much as possible.
          I just can’t shake some lingering concerns…. do antibiotics really clear up an infection in the graft, or should I have had it all removed and cleaned out? I am glad that the bad pain is gone after antibiotics (I am still taking them), but is it normal to feel some pressure and tenderness while the graft is healing? For how long? (For instance, when I bend over, it throbs a bit as if the blood flow is restricted.) Once I have had an infection in the bone graft, is it likely to come back again?
          I have had so much trouble with this tooth my whole life, and after root canal, infection, extraction, grafting, removal, more grafting, infection…. I’m not sure I know what pain is normal any more.
          Also, is it more likely that a bone graft on one of the front areas (#8) would be more painful or sensitive than in some other area of the mouth?
          I would really appreciate your opinion. Thanks!

          ~Sarah

          • Ramsey Amin DDS says:

            Hello Sarah,
            Some **very large** bone grafts may take time to heal and some of the symptoms you described can be normal. We are all built a little bit differently inside.
            Antibiotics definitely can help. The pressure and tenderness you feel may stay for a while. Just give it some time and stay under close observation with your dentist. Head movement is sometimes a problem for people that have had sinus problems.

            Hang in there, having a dental implant is usually a very straightforward process when done with an excellent implant dentist. It is by far the absolute best way to replace the missing tooth. The short-term sacrifice will be worth the long-term benefit. Some dental implants situations are far more difficult than others. This week I extracted 10 teeth from a woman and placed 12 dental implants of the same time and she had zero pain. I had another patient that only had 2 implants and had to use ibuprofen for several days. Both of them will end up having really good teeth, but some people heal better than others.

            Ramsey Amin, DDS

  114. Carolyn Crowley says:

    Dear Dr. R,
    Due to a dental error and health care I had to get two lower left molars extracted due to infection and bone loss…the teeth extracted were not decayed…I had two bone grafts and a tissue implant in my lower left molar area 4 months ago. My gum area is still painful and my upper molars have pain as well…Just wondering why this discomfort is lasting so long…chronic pain is weary…I am having implants placed in May 2014…I keep thinking I have cancer in my mouth…I had CT scan of my sinus…which did not show any anomaly…I do have a low white blood count as reported through blood test results…My right side of my mouth cavity is perfectly healthy…chronic pain on left side…I wonder and worry…could you reflect on this please…Thank You!

    • Ramsey Amin DDS says:

      Hello Carolyn,

      Something seems strange here. Used should see your medical doctor and be checked for any underlying disease. Many people have undiagnosed immune system problems, diabetes, kidney or liver function issues that affect the way bone heals. I have seen this personally on several occasions.

      I recently had a patient that was diagnosed with a rare infection call Brucella while undergoing dental implant treatment!

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

  115. Carolyn Crowley says:

    Dear Dr. R., (Carolyn Crowley reply to you suggestion)
    I had a complete physical in December by my internist. All doctors, dentists and oral surgeons are saying everything looks Okay…But I am feeling so much pain…No one to turn to…Maybe I should go to the E.R. Another thing to mention, I take Singular and Claritin both 10 mg. daily to prevent allergies while I winter in Florida…I have been taking for a year. Could this lead to dental pain…but only on left side? Thank you for your replay…My local Doctors are in Michigan…but I had everything checked before I left town and complained about my chronic pain…they said I may have neurological pain…I have spent so much money already trying to get healthy…This all started with a lost filling in my lower left molar and lead to two new crowns, two root canals, two teeth extractions, 2 bone grafts, tissue implants and still pain and future new implants and 2 new crowns to add to my $10,000.00 bill…AND I HAVE good Dental and Medical coverage but this is way beyond cost coverage…Uffda!!! So hard…

    • Ramsey Amin DDS says:

      Hi Carolyn,

      Something not related to your dental implants is going on. See another MD and keep me posted. Good luck, I wish I could help you online.

      Dr. Amin

  116. Jordan says:

    Dr. Amin, 7 days ago on 2-12-14 I had all four impacted wisdom teeth extracted, and a bone graft on the lower right due to waiting too many years with intermittent infection causing the impacted tooth to wear away the bone supporting the next tooth. I was put on Penicilling 500mg 4x day for five days, and ibuprofen 400mg 4x day. It is now 7 days later and I am in severe pain only on the bone grafted area, similar to the pain I felt when the tooth was infected prior to extraction. (infection cleared before extraction) The pain is subsides 45 min after taking 800mg ibuprofen (prescribed dose doesn’t do it) and comes back like clockwork 3.5 hours later, with sharp, aching nerve type pain that I can feel from my ear canal to my mid lower jaw bone. The pressure I feel is extreme and I would say at night it is 9 out of 10 (10 being only relievable by a shotgun). I have no pain anywhere else and the healing looks fine and swelling gone everywhere except some in the painful area still. I have small amounts of grafting particles working their way out every day, no bleeding and just cannot go without the ibuprofen. I am 31 yrs old with no medical issues at all to speak of. Is this relatively normal? If so how long should I expect to be woken up at night gripping my pillow wishing for an asteroid to land on me? Thanks.

    • Ramsey Amin DDS says:

      Hi Jordan,

      I hope you are doing better now. Some wisdom teeth can be quite painful. Did it hurt before you removed the tooth? That is a big factor in your postoperative pain. Are you still in pain?

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

  117. AD says:

    Needing information. I have been to the dentist 10 times since November 2014. It started with a knot in my mouth and a couple numb teeth. After x-raying the teeth, my dentist sent me to an oral surgeon. He did a biopsy but could not find the knots once he had pulled my gum down. He did find a hole going through the bone just under tooth #29 (a tooth that had a root canal a few years ago). The oral surgeon would not close me up until he did a bone graft. I went to my dentist a week later and had the tooth pulled (that tooth showed no visible signs that the root canal had failed…no visible fractures or anything…my dentist wasn’t sure that he wanted to pull the tooth. There have been 2 dentists and 2 oral surgeons discussing what to do after looking at the x-ray and the picture the oral surgeon took after opening up my gum). What the oral surgeon sent for biopsy came back with the following findings: Final Diagnosis: periapical granuloma and chronic osteomyelitis. Comments: While the patient’s history of paresthesia may reflect the chronic osteomyelitis, we recommend close clinical follow-up. Re-biopsy is recommended in the event of persistence of symptoms and lesional tissue. Microscopic Description: Sections show a soft tissue specimen which consists of a chronically inflamed fibrous connective tissue which is in association with scattered spicules of vital bone. Portions of the bone spicules show prominent osteoblastic rimming.
    This was six weeks ago…now I have the first knot, a second knot (both feel like bone and are nowhere near the tooth that was pulled), a bony looking piece coming through the front of the gum where he did the graft, ear pain (comes and goes), some swelling in my mouth where he did the biopsy, and still have numbness and some pain in the tooth next to it. Is this a sign my body could be rejecting the bone graft? Not sure where I need to go at this point…have collected my xray, the picture, the biopsy report, and made an appt. with a medical doctor 2 weeks from now. Any information as to what could be going on or what I should do would be greatly appreciated. Sorry this is so long. Thanks a lot.
    I have medical insurance but no dental. The oral surgeons office will not bill this under a medical code so I really can not go there again.

    • Ramsey Amin DDS says:

      Hi AD,

      Osteomyelitis is a serious complication of the jaw. You need to be looked at closely as it may recur. You may need intravenous antibiotics to treat this. It is a rare complication that usually occurs on a person that has medical problems already.

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

  118. Jennifer Page says:

    Hi Dr. Ramsey,
    I just wanted to let you know that I came across some of the “YouTube” videos you have posted regarding bone grafting and tooth extraction. I wanted to say “Thank You” for all your helpful information you have shared. I am recovering from a socket bone graft after a tooth extraction this week. Your information you share is comforting, extremely informative and helpful to those who are seeking more information before such procedures and or are healing from these types of dental procedures. I just wanted to express my gratitude to you. Great job! :-)
    Sincerely,
    Jennifer N. Page (Grass Valley, CA) 3/4/2014

  119. Anna says:

    Hi Dr. Ramsey,
    I had a bone graft on the front tooth eight weeks ago and am quite an excessive worrier! Despite the time since the procedure was performed it often bleeds quite a lot when I take the essix retainer I have out, or clean the site with damp gauze. It also looks very red and sore, with my hygienist saying that it was swollen and to do salt water washes (I have). One or two bone graft particles are still coming out each week also, odd since the dentist said my gum was healed over. Is this all normal? One more thing; I have had mild tonsillitis over the past few days and have been given antibiotics yesterday which the doctor said to wait two days to use only if it gets worse (they were not sure if it was viral or bacterial but it does now seem to be improving), but is there any chance this could spread to the graft?
    Thanks in advance for your help,
    Anna

    • Ramsey Amin DDS says:

      Greetings Anna,

      Sounds like your bone graft is healing slow. Antibiotics should be used judiciously. The tonsillitis may make your immune system a bit weaker and possibly introduce some environmental changes for the bacteria already in your mouth. You can always culture any pus or oral fluids to find out what kind of bacteria are present and give antibiotics based on that if needed.

      Bone grafts that heal slow like this may end up with softer bone. You probably want to let it heal longer than normal before placing your implant.

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

  120. Paige says:

    Hi.
    Just yesterday i had one of my right lower molars taken out due to an abscess and a bad tooth. They put in a bone graft so i can get an implant and they told me that it was normal for a white film to build up around the extraction site. What i want to know is if it’s normal for it to be super buldgy, like a ball coming out of my gums? And if so.. Is it supposed to be falling apart? It really has me worried.

    • Ramsey Amin DDS says:

      Hello Paige,

      The day following a dental extraction and bone graft makes the gums look unusual. I would have to see you in person to tell you if it is normal. You are likely healing and it will just take some time.

      Very respectfully,

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

  121. Joseph says:

    Hi Dr Ramsey,

    Thank you very much for this forum.
    I had a bone graft (#30) nineteen days ago to rebuild lower jaw for an implant.

    At one week – day 6 – the pack began to disintegrate and then was removed by my dentist on day 7. The removal revealed a reddish area (interior gum #31) – with tiny white-ish fragment/bone? showing thru the gum. Probably 1/4″ x 1/8″ max… almost sheer to the gum surface. But I see it. At that time I was on Amoxicillin (330mg 3 x day) He changed my antibiotic to to a combo (500mg Clindamycin combined with 500 mg Metronidazole 4x a day ea.) At that time he also took a gum culture from the outside of #30 where the graft is (it was swollen and slightly pussing) 3 days later result came back that I had a pneumonia. (weird I didn’t feel bad). I saw the dentist at Day 13, Puss was gone, swelling started reducing. So we (I :) have stayed on the same Antibiotic routine.
    It is now day 19… I feel pretty good except fatigued and face rash from the Clinda I think + Insomnia. The swelling is reducing slowly but surely – red area on gum too but I still see the bone frag. Also my stitches are still in.

    Is this normal?

    I have had very little pain. None at all now. Never needed more than a couple OTC Ibuprofen. My next check up is in two days which will be when my Anti-Biotic regimen is complete

    Just wondering if this is normal…?
    mostly worried about all these antibiotics… I have rarely taken in my life and he mentioned another 10 days possible? Yikes!

    I would also like to get a 2nd opinion. I am close to you ~ Pasadena / Burbank area.

    I appreciate your input and professionalism.

    Joseph

    • Ramsey Amin DDS says:

      Hello Joseph,

      If this were normal, I don’t think anybody would ever have a bone graft or a dental implant. That being said complications do happen and sometimes patients need to be treated with multiple antibiotics over an extended period of time if bone becomes exposed after having a bone graft.

      This greatly depends on the type of bone graft that you had. A socket bone graft heals completely different than say an onlay block bone graft with fixation screws. That is great that your dentist cultured the bacteria and found out what antibiotics work on it. Some people get dental infections with very strange bacteria that are not normally found in the mouth or are considered more unique.

      Stay the course and hanging in there. I’m sure things will resolve. I would love to know what type of bone graft you had.

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

      • Joseph says:

        Hi Dr Ramsey,

        I had a Bone Block 15x12x35 (Rocky Mountain Tissue Bank will be offering Irradiated Cancellous Cadaver) Bone w 2 screws, alloderm membrane and 1 grm ICBM. The surgeon is very renowned – AAID pioneer, my dentist assisted. I’m not complaining just covering my bases.
        I have learned alot about antibios in the last 24hrs because of my concern (gram positive vs negative and what they can and cannot do. Metro can be conflictive.
        I see my Dentist in the AM to check on this. It seems to be healing. However Klebsiella Pnumoniae can be caused by health care workers. I saw a few Most likely where I got it… So we’ll see. I’m also hoping to get in to seemy MD tomorrow to see if these antibiotics are helping/hurting. I don’t smoke or drink. 50y/o recent full physical 30 days ago w flying colors. I’ll keep you updated. We all learn from one another. Thnx j

      • Joseph says:

        Hi Dr Ramsey,

        I had a Bone Block 15x12x35 (Rocky Mountain Tissue Bank Irradiated Cortical Cancellous Cadaver) Bone w 2 screws, Alloderm membrane and 1 grm ICBM particulate. The surgeon/s are very renowned – AAID pioneer. I’m not complaining just due diligence in covering my bases.

        I have learned alot about antibios in the last 24hrs because of my concerns (gram positive vs negative and what they can and cannot do.) Metronidazole can be conflictive in causing Klebsiella. My dentist prescribed Before the result came back and did not let me know immediately.
        I see my Dentist again in the AM to check on this. It seems to be healing. However Klebsiella Pnumoniae can be caused by health care workers. Most likely where I got it… So we’ll see. I’m also hoping to get in to see my MD tomorrow to ascertain if these antibiotics are helping/hurting. I don’t smoke or drink. 50 y/o w recent full physical 30 days ago. In perfect health. I’ll keep you updated. We all learn from one another. Also based on the specs I provided that also included IV sedation … wondering what your approximate charge would be for something like this?
        Thank you J

        – See more at: http://www.burbankdentalimplants.com/bone-graftshow-long-do-they-take-to-heal-dentist-in-burbank-video/#comment-3026

        • Ramsey Amin DDS says:

          Hi Joseph,

          It sounds like you are in good hands.

          What is the name of the implant surgeon and your dentist?

          You had a very large block graft to correct a large bone defect. The larger the graft, the more likely you are to have complex healing.

          Dr. Amin.

  122. Rex says:

    Hello Dr. Amin,

    Having full upper arch reconstructive done with 2 sinus lifts. Lifts Where done March 27. Right side seems no problem left side how ever not so much. There seems to be swelling just under my left cheek. I can apply pressure to it and seem to go away for a short while. I can also hear sounds coming from inside my sinus cavity when I do apply pressure just under my cheek. My first thought was bone grafting material is coming from sinus lift. Any thoughts?

    • Ramsey Amin DDS says:

      hello Rex,

      Did you have a traditional lateral window sinus bone graft? Did you have internal sinus lifts at the same time the implants were placed?

  123. Gita says:

    Dear Doctor Ramsey,

    I had 2 extractions upper jaw molars on same side.

    My periodentist then explained he would build the height and do a sinus lift later.

    I received granule bone Nd was stitched up with membrane and goretex stitches.

    I felt fine had very little swelling…I ve been diligent about cleaning ect.

    But before my post op visit I felt most the height or bone he packed in came out I can feel deep holes on both sides with some height in the center…

    He saw me quickly today took an X-Ray had the nurse take part of the stitches out and asked for me to come back for a check up next week…shouldn’t he add more bone? He did mention this process would take one year…I had a horrible taste in my mouth the nurse explained the stitches were to blame….

    Not certain what he s thinking in terms of my overall case….I thought he would of at least scheduled me for a re packing of the bone…what could he be waiting for?

    Thanks so much for taking the time to answer me….

    Gita

    • Ramsey Amin DDS says:

      Hi Gita,

      Sounds like you had socket preservation bone grafting when the two teeth were extracted. It also sounds like you lost the membrane cover and the particles of bone came out.

      If this occurs, this would not be the appropriate time to replace any bone particles that came out. It would be better to wait until later when the bone has healed more.

      Often times dental implant Bone grafting has to be done in stages. Meaning just adding a little bit at a time.

      Ideally no bone is lost. But techniques vary from one dentist to another. Experience, training, and judgment of your dental implant surgeon is critical to the short and long-term success.

      The key to having a dental implant for as long as possible is strong healthy stable bone around it. But just because you lost some bone at the initial bone graft this does not mean you will have long-term problems per se.

      I hope this helps you.

      Respectfully

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

  124. Ray says:

    Hi Dr. Ramsey,

    I had a fracture on my front tooth #9 from a trauma cause 2 years ago. Denist indicated that the nerve dead and the tooth can not be save. So, I went to a Implant Specialist and she extracted the tooth and placed bone graft in about a week ago. Now the stiches are coming out, is that normal? She also inform me at the time of the extraction that we will proceed with the implant 3 months later, I notice you indicated that it take at least 4 months for the bone to heal. Would the implant be too early to do?

    Thanks,
    Ray

    • Ramsey Amin DDS says:

      Hi Ray,

      Many stitches dissolve in about a week so that is normal.

      Bone grafts having varying degrees of healing times. The smaller the graft the faster the bone can turnover to new bone. The type of bone graft used will also determine the time frame for healing. In general, most grafts are more mature at 4 months than at 3 months.

      Some huge bone graft that I do to reconstruct an entire jaw will require 7-9 months to heal.

      It is not wrong to place an implant into that area of the mouth at 3 months.

      Good luck!!

      Dr. Amin.

  125. Rochelle says:

    I had a sinus lift/ bone graft two weeks ago. I just had my sutures removed Thursday and my dentist said that everything looked great. I am now getting a very light but bad tasting fluid from the area, there is no pain, swelling or any other symptoms. Does this mean I have an infection and the bone graft will have to be redone? Thanks for your response!

    • Ramsey Amin DDS says:

      Rochelle,

      This does not mean that the sinus augmentation bone graft has to be redone. You may have an infection that requires further treatment with a secondary antibiotic. Are you still on the antibiotics at this point?

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

  126. Laura says:

    Hi Dr. Amin,
    My front four teeth are weak and highly mobile due to bone loss. I’ve been told my only option is to have the teeth removed, bone grafting, and implants. I am only 35 years old and the thought of removing my front teeth for 5 months while the graft heels is extremely disturbing for me (even with temporary teeth). Are there any other methods that I can ask my periodontitis about that do not involve extracting the teeth?

    • Ramsey Amin DDS says:

      Hello Laura,

      It sounds like you situation must be pretty bad. Sometimes extraction is the only solution. Oftentimes immediate dental implant placement is not the best idea in the presence of bone loss.

      If her teeth are highly mobile it means that there is less pre-existing bone to anchor the new implants into. Going slow and steady in your case may be the best possible option.

      Saving loose teeth is never a good idea.

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

  127. Elizabeth says:

    Hello. I just received a bone graft following the extraction of an extremely decayed tooth. I had the surgery almost a week ago. Just within the past few hours, I have noticed an extremely foul smell coming from the extraction site. Is this normal? It also seems that one of my stitches has come undone and I can see it hanging down from my mouth. I have taken every precaution my dentist has given me and I am so freaked out! Thanks.

    • Ramsey Amin DDS says:

      Elizabeth,

      If it smells bad, there is a good chance you are developing an infection. What antibiotic were you on and how long? The stitches are not likely a problem if this was a socket bone graft.

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

  128. Siobhan says:

    Hello Dr Amin
    One of my canine (eye teeth) was removed four months ago. I suffered a trauma to the root of this tooth during orthodontic surgery at age 13, resulting in root canal treatment and posing of a crown fifteen years later and subsequent reinfection and bone loss ten years on. So today I need an implant and bone grafting. It looks like I have width and height missing and the front (visible) walls of the gum/jaw are definitely missing. I consulted a dentist yesterday who performed a 3D scan and wants to perform a graft and implant on the same day as soon as possible. Previously I’d been told my treatment could take several months if not years to complete! Should I be concerned?

    • Ramsey Amin DDS says:

      Hello Siobhan,

      this is an excellent question you have submitted. I’m assuming this is an upper canine. The upper canines are the longest teeth in the mouth and can be difficult to replace as an immediate one stage implant.
      I perform immediate dental implants on a routine basis for the last 15 years. This means that the tooth is extracted and the implant is placed on the same appointment. This should only be done if it is a safe and predictable as extracting, placing a bone graft, and coming back at a later date. The upper canine tooth is not considered implant for a novice dentist.


      That being said, if you root is very short and there is enough bone beyond the end of the root, then immediate dental implant can be the very best idea.
      That being said obviously I would have to see you to be able to tell you this exactly.

      Sorry for the delay in responding to your question… For some reason your comment got caught by the spam filter!!

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

  129. Karen says:

    I had a bone graft done a month ago. I was on an intravenous antibiotic, then oral ammoxicillin, and metronidazole. I have been off the antibiotics for the past 3 weeks but am still tasting a metallic taste in my mouth. The surgery site is healing well and there is no pain; just this metal taste in my mouth. Do you have any idea how long this taste will last?

    • Ramsey Amin DDS says:

      hi Karen,

      The metallic taste is oftentimes a side effect of antibiotics and a mouth rinse called Peridex (chlorhexidine gluconate). It should go away soon. It is not permanent and is not related to the dental implants but rather the medications.

      Dr. Amin

  130. Selene Rucobo says:

    Fresno, CA. I’m a 40+ yr. old adult w/ tooth #H still in place. Had implant w/bone graft procedure done 12 days ago, but didnt receive much in the way of post-op instructions, except for 1. don’t chew ice (bad habit of mine), 2. place ice pack on site for 20 mins. through out remainder of day (to minimuze swelling), thats it. Oh, and also, if something doesnt seem right, call Dr. office, no mas! Well ive been off the ice, but somehow I lost a stitch holding frontal & paletal gums together. Have pretty significant piece of frontal gum flapping every which way and looking kinda nasty underneath. Looks whitish like major plaque, or infected, but no pain. Not knowing what to expect, I’ve been stressing out for a few days now. Called office, was told “see you on the 3rd”. Ive called my dad, my sister, asking what is it supposed to look like? Didnt get much info to ease the stress, till I found you, Dr. Ramsey, you are awesome! Thank You so much for explaining what I should be looking at inside my mouth. I can rest, and not try to mess w/it. Might get a second implant in the future on #4, I will make a mental note to call your office for info. on said procedure. Once again, Thank You, and keep up the good work on informing us pts. who have no clue.

    • Ramsey Amin DDS says:

      Hi Selene,

      You’re very welome. Thank you for your very kind words. It sounds like the dental office does not do very good follow-up.
      Many dental clinics have a traveling dental implant surgeon. The problem with this is they are unavailable to see you in time of need or when complications arise. They are only at that 1 office once a month!

      Next time, travel to Burbank. ;)

      Again thank you for your very flattering words

      Dr. Amin

  131. Kathy says:

    On 5/28, I had a 15 molar extraction and bone graft done. The plan was to also do the implant insertion but during the procedure it was discovered that there was an infection (on the 4th day of augmentin) and that there was less bone there than expected, especially the side cheek wall. I recall the surgeon telling me that he took some tissue from my cheek wall for needed tissue in the surgical process. I was in the dental chair from 9:15 until 11:45, not because it took that long but because he surgeon was called out of the room 3 or 4 times for emergency reasons/consultation.

    I was scheduled for a followup on 6/5, but on 6/3, it felt that sutures (or something else) was hanging down and I was concerned that something was wrong so I called and left a message. They had me come in one day earlier on 6/4 and he quickly saw me in the consultation room. He said everything looked OK…no problem with the sutures but it looked as if I had touched it with my tongue and that I needed to leave it alone. I know not to touch it with my tongue and thought I had not done so unless it was unconscious or in my sleep. He said it was OK but there was a scab and the flap needed to be left alone to stay in place. BTW, for several years I’ve worn a small mouth guard on my 2 front teeth so my back teeth do not touch and grind in my sleep and when I asked, he told me to continue wearing it.

    When I woke up this morning, I could not ignore the end of a suture that falls down below my back tooth. I am not touching the surgery part but I can’t miss the end of this suture hanging below my last tooth. I went to the drugstore and bought a dental mirror and this is what I can see. Along side my last tooth, there is the end of a suture handing down and a bunch of suture threads knotted in a wad along the back side of my tooth. As for the surgery area, I see something exposed that is white. I guess that is the bone graft but part of it is exposed and not covered by gum tissue. Should this be exposed? If the sutures are not keeping a flap of tissue over the white exposed bone grab, will the tissue grow over it on its own?

    My next followup visit is scheduled for 6/11 and today is 6/5. I’m concerned about this now but I had to be a pest calling the oral surgeon again, after seeing him just yesterday. Should I call or wait the 6 more days until my visit? I’m surprised he could not see the end of the suture hanging there. I feel it all the time, not by touching the surgery area but because it hangs below my last tooth. I can seeing it hanging below my last tooth and so can my spouse.

    • Ramsey Amin DDS says:

      Hi kathy,

      First of all, in my office a bone graft the sterile procedure. Once I am in a sterile procedure I do not get up to leave for another consultation. That is very strange. The focus should be one patient at a time!

      Dangling sutures should be removed. The only attract plaque. The white part that is exposed may be a membrane or maybe bone. If the gum is flapped open it will not recover itself even by Re-suturing. It is best to allow it to heal in secondarily by filling in. The bone graft may not take and may need to be removed and done again. Being that this is tooth number 15 it is likely that an internal sinus lift would be necessary after the areas healed. I personally do the internal sinus lift at the same time as the implants itself to avoid two bone grafts.
      I hope everything works out for you.

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

  132. Brenda says:

    HI, I am to have bone grafting done in back area of upper right and left jaw bones along with 4-5 areas of gum grafting also on upper and lower teeth on both sides. Is it okay to have all of this done at the same time?
    Thank you so much for your answer.

    • Ramsey Amin DDS says:

      hello Brenda,

      It is not uncommon to group together several surgical procedures. Most importantly, is this skill, training, and judgment of your dental implant surgeon. There are times when I place between 12-18 implants at the same appointment if the patient is healthy enough and it makes sense to do it together. Each situation is unique, every dentist is quite different and of course every patient has their own level of tolerance for dental procedures.

      I would highly suggest IV moderate sedation for long surgical procedures in order to decrease swelling, pain and postoperative complications. Keep in mind that removable temporaries placed over bone grafts and gum grafts can ruin the grafts and cause immediate failure. Make sure you in your dentist have a plan for how to handle temporary teeth over grafted sites in your mouth.

      Good luck to you… Keep us all posted

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

  133. SJ says:

    Hi,
    I had an extraction and bone graft on #14 about 3-4 weeks ago. A couple of months before that, I had a second root canal on that tooth ( the first was about 7 or 8 years ago). I continued to have pain, so the tooth was taken out and the root filled in (that is grafting, right?). It seems to be healing ok, except that I sometimes have a dull ache inside my gum where the tooth was. Is this part of the healing process, or is there something wrong? Could my doctor prescribe some Tylenol 3 at this point, or is it too long since I had the operation to ask?

    Thanks.

    • Ramsey Amin DDS says:

      Hello SJ,
      You need to see your Dr. for a follow-up visit. There is a chance you may be infected. Trying to cover up an infection with Tylenol 3 is not a good idea. It should never be too late to ask your Dr. anything!
      And yes, it sounds like you had a bone graft. You should know what type of bone material was used also. Being well-informed patient will help you always.

      Good luck,
      Ramsey Amin DDS

  134. margaret coleman says:

    Had peridontial surgery 19 years ago and had a bone graft at that time for my front tooth. It took fine at that time, then about 4 years later had to have the graft re done. Had some trauma to the tooth taking a fall 5 weeks ago and the tooth seems loose again. Can the graft be repeated or does the tooth need to be pulled and another graft and implant be in order. Not sure if I’m even a candidate for an implant. Can you shed some light on this. I’m 57 years old and in good health. Tooth has no pain, just slightly loose from the injury. Hoping another graft or something to that effect can possibly correct the problem

    • Ramsey Amin DDS says:

      Hi Margaret,

      Your age is not a factor. As long as you are healthy, having a dental implant or bone graft is generally smooth procedure.

      The loose tooth should be splinted, meaning connected to your other teeth in order to stabilize it while it has the chance to heal. If it keeps moving around it will likely die or be lost. There is a possibility to do another bone graft but I would need to see your x-rays and your clinical situation in person. The bite on the tooth should also be removed so that you cannot make contact with it while it heals. Don’t chew on that site at all!

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

  135. Hanna says:

    Hello Dr,

    I have a question I was hoping you can help me with.
    I am supposed to be having braces put in this week, but was told by my doctor that I have one tooth in my upper jaw that showed dental bone loss. For that they are will only be placing the braces at the lower jaw until I get a bone graft for that tooth in my upper jaw.
    My concern is that I really don’t want to delay the braces for my upper jaw because it’s the cause I considered braces in the first place. So if I get the bone graft done (which by the way I do have a healthy tooth at its site it’s just the dental bone causing the problem) How soon can I get the braces on that jaw after the bone graft?

    Thank you for taking the time.

    • Ramsey Amin DDS says:

      Hi Hanna,

      The bone graft should be allowed to heal for 4 to 6 months prior to doing orthodontic treatment. If the teeth start moving, the graft will not take.
      If you had a broken arm in a cast, and he started moving your arm around, the bone would not heal either. I would suggest waiting this period of time.

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

  136. Stephanie says:

    Good Afternoon Dr. Amin,

    I have had extensive dental work over the years and have major work that still needs to be done. I should probably mention that I was diagnosed with periodontitis several years ago. I had two extractions and two bone grafts (in the upper left quadrant of my mouth) performed with a periodontist about a year ago now. I never finished with the implants, as my periodontist is not part of my dental insurance plan. After several thousand dollars, I simply ran out of “disposable” income and had to cease the process for a while. All this to say, yesterday, I felt I was getting an abscess over one of the grafted areas. Today, the swelling was much worse and is now throbbing and coming to a point in my gums.

    I saw my a new dentist today, and he told me he suspects my bone graft is failing after all this time – that he sees infection and it looks like a piece has broken off and is moving up and out. I was instructed to see my periodontist as soon as possible today. But his receptionist informed me that he is out of town until mid-week next week. I placed a call to the dentist for advice, but haven’t heard back.

    My question comes down to this – should I seek emergency care for this in the meantime? Or will the piece of bone work its way out on its own? My dentist did prescribe antibiotics for the infection.

    Thank you so much for this board and for your willingness to advise people in need

    Regards,
    Stephanie

    • Ramsey Amin DDS says:

      Hello Stephanie,

      Having an abscess over a previously bone grafted area for a dental implant is not that common. The bone may or may not work its way out on its own. The antibiotics will likely help tone things down for a while and buy you some time until your regular dental implant dentist can see you.
      Without seeing you and your x-rays, it is difficult for me to tell you otherwise. Most bone grafts are articulated materials that have the size of small granola. If one of these tiny pieces comes out it means that it was never integrated in the first place. This does not mean that the entire bone graft is going to fail because of one particle that did not integrate.
      Have faith that things will go okay. Thank you for your very kind words. I wish you the best.
      Ramsey Amin DDS
      Burbank, California

  137. Miriam says:

    First of all, thank you Dr. Amin for being so selfless with your time. I had my front five teeth extracted (along with 3 infected 18 year old implants) and two rounds of bone grafting done. It has been two months since the last graft and every day since, one to three granules pop through my gum tissue (upper jaw.) These granules seem to be preventing the gums from healing back all the way. Should I be concerned about this going on for so long? Thank you so much for generously sharing your knowledge.
    Miriam

    • Ramsey Amin DDS says:

      Hello Miriam,

      It sounds like you had some sort of particulated bone graft placed. This means that the bone graft comes in granules rather than a large block of bone that may be screwed into your jaw.

      You should definitely have your dentist who did your surgery have a look at you. It is not uncommon for some granules to come through the gum. Every situation is so different.
      Most of the time the granules would stop coming out after about one month if you had anything at all. Thank you for your very kind words and good luck with everything. Keep us all posted for the benefit of all.

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

  138. Chris says:

    I have been reading through the site for the last month and found it very informative. Wondering if you could give me some guidance. Bit of a long story.

    I am currently going through the implant process for my top front teeth. I lost them when I was 8 in a car accident. Now 29 years old I have been able to finally afford to get implants and forgo my partial denture.

    I had the bone graft done about 4 weeks ago. After 3 weeks there a very small hole appeared in the gum and leaked green pus (gum – on the right side of the bone graft site), and also a small build up of pus in the gum over the membrane.

    My dentist who is a implantoligist and surgeon said the infection was being caused by the membrane and that the bone graft is safe as the gums have completely healed over the bone graft. He gave me antibiotics and to come back in a week.

    At the follow up my dentist lifted the gums, removed the membrane, irrigated the area and stitched my gums back up. He gave me instructions to try not to disturb the bone graft site to much for the next 3 weeks (no pressure on it when eating etc.) and gave different antibiotics.

    The day after – the same small hole that was leaking pus – was leaking again, but this time it is a disgusting foul smell and foul taste (rotten smell). I called the dentist office and the said it was normal for a few days after for the drainage to continue. I go back in a weeks time for another follow up.

    A this point I am so scared and worried with everything that is happening.
    I trust my implantologist completely and he said it isn’t all going exactly to plan, but that happens and that he will do another bone graft also when he inserts the implants in 6 months.

    Any information you can provide I would be more than grateful. The smelly drainage is awful

    • Chris says:

      should quickly mention it is for my 2 front teeth. All my other teeth are fine. :-)

    • Ramsey Amin DDS says:

      Hello Chris, sorry for the delayed reply. I was on vacation for a while.

      It sounds like you have what we call dehiscence of the incision line. Your likely going to lose some degree of bone volume. I find it a little bit odd that the membrane was removed and you were resutured. Typically re-suturing and wound does not hold and sometimes more bone becomes exposed. Plan on needing some degree of secondary bone grafting. The infection is eating away some of the bone. Sometimes a culture of the bacteria needs to be done in order to know the type of bacteria that is causing this. This may require a change in antibiotics or using 2 antibiotics at the same time.

      Please tell me how it is going now. Please reference your story so that I can find you amongst to 295 other comments.

      http://www.burbankdentalimplants.com/bone-wideningexpansion/
      Very respectfully,
      Ramsey Amin DDS

  139. Chris says:

    should quickly mention it is for my 2 front teeth. All my other teeth are fine. :-)

  140. bev says:

    Hi, I had a front upper crown removed 5 days ago. The reason was dentist said there was bone shrinkage,so he suggested a denture. I had the crown and post removed (although he left a bit of the post in as it would not come out and he said he did not want to drill too far as it was near my sinus. The denture was put straight in on a palate.
    It was the biggest mistake i have made as i can not get used to the denture nor do i like it. Is it possible to have another post and crown inserted at this stage
    Thanks

    • Ramsey Amin DDS says:

      Hi Bev,

      I don’t really understand the way you have described your situation. Can you try to rephrase that?

      Respectfully,
      Ramsey Amin DDS

  141. Jackie says:

    Dr. Ramsey,
    My dentist had to extract my tooth # 15 back in April and told me that he needed to do a bone graft. I kept going for his office every few weeks for him to check so he scheduled the implant date few weeks ago. On the day of putting the implant in he tells me that he needs to graft it again since nothing is formed so he ended up cutting, scraping and grafting again which was more painful later that the first time. Is this normal?
    Thanks
    Jackie

    • Ramsey Amin DDS says:

      hello Jackie,

      It sounds like you had a failed bone graft. The intention of the bone graft was too rebuild the area to successfully place the dental implant. This kind of strange that nothing formed at all.

      I would highly suggest you take a 3-D scan CBCT 4-6 months after the bone graft. This will allow you to know if the bone graft developed enough bone volume to place an implant before ever cutting into you. Almost every single patient I treat with a bone graft gets a 3-D scan prior to implant placement. You need to know what you are drilling into!

      http://www.burbankdentalimplants.com/ct-scan/

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

  142. Samantha Stone says:

    I have had two lower molars extracted. One from the right side and one from the left. The left was extracted at least ten years ago, the right about a year ago. I can swear my jaw looks smaller. I’ve been to periodontists, that basically say it’s in my mind. I had a small face to begin with, but I’m sure my jaw has shrunk a little. The left side is a bit smaller than the right. I had bone grafting and a implant done on the right side and I will do the left side in the coming months. Is there anything that can be done to return my jaw to the original size?

    • Ramsey Amin DDS says:

      Hello Samantha,

      What you describe is not completely uncommon.

      Facial shrinkage can be due to a lack of stimulation to the muscles of the face. When a person loses teeth especially in the back, their muscles don’t have to work as hard. Because the muscles are not working as much, the face begins to sag and sometimes dips in. This is referred to as facial atrophy.

      I find this to be more common in patients that are missing all of their back teeth or all of their teeth entirely. I have seen it on occasion on a very thin build female where missing just one molar on the lower jaw causes a reduced functional output of the muscles thereby resulting in a possible cosmetic change. We all notice ourselves more than others notice us.

      The featured case on this link underwent zero plastic surgery. http://www.burbankdentalimplants.com/smile-gallery/

      After having her teeth for a while, her muscles of her face came back and you can see that she looks completely different. She had an upper and lower Prettau dental implant bridge to replace all teeth

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

  143. Vicki says:

    Hi,

    I had a bone graft about 8 days ago and it seems like the graft material caved in in a few places.Is it OK? It doesn’t look that I might have an infection. I still have the stitches to be removed. Maybe more graft material can be added to the places where the graft has dipped?

  144. Vicki says:

    Dr. Ramsey,

    It has been more than one week since I gone my bone graft. It seems like it has deepen in a few spots. Is it OK? Can the graft be added to the spots where it seems to be missing now?

    • Ramsey Amin DDS says:

      it is best to leave it alone. Do not try adding bone graft material a week later. It will not take. Without seeing you in person there is no way that I can tell you more detail than this.

      Ramsey Amin DDS

  145. Jackie says:

    Thank you so much Dr. Ramsey for your quick reply.
    About a month ago they took a 3D scan and told me it looks great but it’s better to wait one more month but when I went in to get the implant that’s when they told me that there was nothing formed. It doesn’t make sense to me either.
    Can I make an appointment to come and see you and maybe get my implant when I am ready for one?
    All the Best
    Jackie

    • Ramsey Amin DDS says:

      Hi Jackie,

      The 3-D scan will be able to tell you whether or not bone formation is proper or not. Please call my office to make an appointment if you’re local.

      I look forward to meeting you
      ;)
      RA

  146. Alyssa says:

    Hello!

    Your website is fantastic.

    I just had a bone graft for my upper lateral incisors ( didn’t have them ). The first time it failed due to infection. ( they had me on clindamycin for 3 days) They tried again by opening up, using ozone to clean it, replacing little bone grits and suturing. I then started azithromycin but it failed again. So I had the procedure redone again after being on azithromycin for 5 days. I seem to be healing nicely but feel like there’s still a tiny bit of pus and I ended my 3rd pack of azithromycin yesterday. I am extremely nervous for the infection to come back and ruin it for the 3rd time. Is there any other antibiotics you recommend, I’m allergic to ammoxicilian. Thanks!
    __________
    June 19th I had a bone graft using tiny bone grits using my own blood for preparation to have implants in my upper lateral incisors. I was on clindamycin a day before and two days after the surgery. I ended up with a bad infection causing the graft to fail. When I went it my doctor opened my gums, cleaned it out with ozone and then re did it really quickly. He did not redo the membrane and the tiny screws- just the bone material. At this time I started 2 rounds of azithromycin. A couple days later I could still feel pus and bone pieces falling out. So 5 days later I went back to have the entire surgery done again. I just finished my 3rd round of azithromycin and am 10 days post op. I am still noticing trace amounts of yellow pus. Mostly in the morning. I figured after 15 days on antibiotics that should have cleared. Is there any chance that I can heal and not have the graft fail again with a small infection still? Should I ask for more antibiotics- or different ones? ( allergic to penicillin family) Ide really appreciate any advice, it would be so hard to go through it again!!

    • Ramsey Amin DDS says:

      Alyssa,

      Sounds like you need what is called a culture and sensitivity to find out what type of bacteria is present and what type of bacteria will kill it. There is no super antibiotic that I can do it all. You may be taking an antibiotic that is not working against your particular bacteria.

      Higher dose clindamycin@1200 mg per day mixed with metronidazole may also help. These are decisions for your Dr. to make.
      Thank you for your very kind words.

      http://www.burbankdentalimplants.com/bone-grafting/

      Ramsey Amin DDS

  147. Rhonda says:

    I’ve had an implant fitted in the upper second pre-molar and would like to know what is the earliest date I can have the abutment fitted and then the crown. From my research it seems the average waiting/healing time is 3-5 months, however I am due to be moving overseas and was hoping to finish the procedure before I left which would only give me 2 months healing time after the implant was fitted. Also, would it matter if I delayed getting the abutment and crown fitted until a year later until I have finished travelling or would this cause problems with the implant and surrounding gum areas when it comes to fitting the abutment and crown?
    I would really appreciate your help and advice on this matter.
    Many thanks in advance

    • Ramsey Amin DDS says:

      Hello Rhonda!

      It is better not to race through your dental implant. Especially if the bone is soft, you would prefer to have more healing time. If you race to put the tooth on, your bite force can damage the bone around the dental implant.

      If anything, your idea of waiting longer to put the abutment and crown on his a better idea. I would go ahead and have the implant now, then do the abutment and crown when you get back.

      It’s like chicken, better to overcook than to be undercooked :)

      ;)
      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

  148. Rhonda says:

    Thank you! I really appreciated your invaluable insight :)

  149. Nicole says:

    My 9-year old son had to have an odontogenic cyst removed along with two permanent teeth. He also had a bone graft done at the same time (he only had 4 mm of bone remaining along the jaw line after everything was taken out). It has been 7 weeks, and the gum still has not closed completely over the membrane. Should we be concerned? Is there anything we can do to help promote the gum closing over the membrane?

    • Ramsey Amin DDS says:

      Hello Nicole,

      Children are so precious. I have kids of my own. I hope your son is healing well.

      It is not always possible to gain primary closure over a membrane. Sometimes the membrane is purposely left exposed. Just allow your son to heal. Nature has an excellent way of fixing things especially in patients as young as your son. I’m sure it will go very well.

      this link may help you with some concepts:

      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, California

  150. debra says:

    hello dr. i had a sinus lift & cadaver bone graft 1 wk ago for 2 future implants, back of my mouth. the stitches were removed 6 hrs ago. some of the gum did not heal together & some bone particles come out & i can see into the cut open gum. sometimes it looks all white, sometimes i see a black spot/hole? should i be concerned that this area did not heal together? it seems like all the bone particles will escape past the membrane patches he placed. my dentist said the lift & graft were more successful than he imagined & that instead of the 5(mm?) implants, he’ll be able to use 8 or 10. what is the significance of this & what should determine the length of the implant? thank you in advance for your time.

    • Ramsey Amin DDS says:

      Hi Debra,

      The upper back teeth has the soft tissues bone in the entire mouth. It is mostly bone marrow and not the hard surface cortex. The bite is very strong in the back upper molars and combine this with naturally soft bone can make a recipe for disaster.

      Generally speaking you want to have implants that are at least 10 mm in length for upper molar teeth unless the diameter is super wide meaning 5.7 mm or greater.

      Again generally speaking, after having a sinus lift, most of my patients will have a minimum of 1 inch or so of additional bone added if it was a lateral window sinus bone graft. This will allow me to usually use implants that are 13-16 mm in length. The longer the implant is for upper back teeth allows for long-term stability in very soft bone.

      Most of the examples on my website and blog will show very long implants when a lateral window sinus bone graft is done in slightly shorter implants when it internal sinus lift is done.
      5 or 8 mm length implants for upper molars is asking for failure. Maybe your are confused that the implants are 5 mm in diameter and not 5 mm in length????

      Please see this link for some clarification:

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

  151. JJc says:

    Hi

    Was involved in a accident couple years ago , lost 4 front teeth , i got bone grafting done artificial bone placed in my front mouth . im currently waiting for this to heal to get dental implaints ( bone graft done in early june – dental implant to be put in december hopefully) i was just wondering is it normal to see parts of maybe the bone graft stick out of the gum )

    • Ramsey Amin DDS says:

      Hi JJC,

      In some situations it is normal to see bone graft particles. It makes a big difference whether or not this is an onlay block bone graft or this is a particulate type of bone graft. Particles are the size of small granola while a block bone graft is like a thick small cracker bone that is screwed into the jaw.

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

  152. Diane Conrad says:

    Hi,
    Several years ago I had my bottom front tooth removed because of a hole in the root of the tooth. I waited about a year before having a dental implant put in because I just didn’t like the idea of drilling into my jaw. There was no pain or problems before the dental implant was put in, December 6th, 2013. After the implant was put in I had pain and throbbing that continued for several months. I took Zithromax during and after the implant was put in and then another antibiotic in case there had been an infection develop, although the dentist did not see any infection and was puzzled why I was still having problems 3 months later. I ended up going to an oral surgeon and having the implant taken out. The pain and throbbing still continued for several months. Then I had 3 weeks where everything seemed to settle down without the pain or throbbing. It seemed to me that the teeth, on each side of the implant, were extremely sensitive and hurting. One night, after gently using a rubber stimudent around the two teeth, the throbbing and pain started up again. This continued for several more months. The oral surgeon just took out those two teeth and placed a bone graft in each area on July 22nd so he could later do two implants. He said I had lots of vertical bone but not horizontal bone. I saw him on August 1st for a follow up and he was happy how well I had healed. No pus, redness, infection. He thought everything looked great. My question to him was, “how come, if there is no infection, I still have the throbbing and pain?” His answer, “I don’t know. With no infection there should not be the high level of pain that you are experiencing”. On a scale of 1-10, the pain has been 8-15. Today it’s about a 7. I took Zithromax and a mouthwash during and after this procedure to prevent infection. I only took Advil for pain because I didn’t think that I could tolerate the Vicodin. His solution would be for me to try the Vicodin. I’m still puzzled, if I healed so well, why there is any pain at all right now. The jaw is also tender when I touch it. I wonder if some damage was done to something in my jaw when I had the first implant put in? Any thoughts you have on this would be greatly appreciated. I’ve now had pain and throbbing for 9 months now.
    Thanks so much.
    Di Conrad :)

    • Ramsey Amin DDS says:

      Hello Diane,

      Pain for 9 months would not be common. My guess is you have some sort of underlying medical condition that has not been diagnosed yet that is delaying your healing. It is not normal to have this degree of pain for so long. You should see a medical Dr. and undergo a very thorough examination. I have had patients have rare disorders that they were not aware of also.

      This can also be caused by intravenous or oral bisphosphonates (such as Fosamax or Boniva) which are often given for chemotherapy or for women with substantial osteoporosis. You may even have undiagnosed diabetes or and immune system problem.

      I tell you these things not to alert you but rather to inform you…. You need to get looked at.

      Very respectfully,

      Ramsey A. Amin, D.D.S.

  153. Karen W. says:

    Hello Dr. Amin,

    Thank you so much for providing this comment service for folks that have questions. Very kind of you to do so.

    I’ll make a long story short. I’m a 62 year old female in good health. Had sinus lift, bone graft on back, left, upper 3 molars in early October (2013). In March (2014), I had titanium implants inserted and the dentist was quite pleased with the results and placement based on a 3D at the time. All has gone extremely well, however, having just seen him again last week for a final 3D before crown placement, I have been told that the bone around the implants is disintegrating. From what I could deduce from the 3D, it appears to be about 40% to 50% of the bone graft is gone. During this visit, the dentist took impressions, completely sealed off all three implants, adjusted my bite so that the resin temporaries wouldn’t rest on the teeth below, told me to eat soft foods and that he would see me in 3 weeks for another bone graft of all three implants WITHOUT removing them. I will have to wait 5 mos. before the crowns can be installed and must wear a custom mouth splint in the interim to protect the bone grafts.

    My question is: Can more bone grafts be inserted into the partially- failed, existing implants that are in place? I am concerned about throwing in good money after bad.

    Also, should the dentist have done a metals test (titanium) before the implants were inserted? I’ve read online that many doctors do the test as a matter of course and am wondering what your opinion is on this.

    Thank you so much in advance for your response and for sharing your extensive knowledge with all of us who desire answers to our questions. You are a very nice man, who is also very polite (your mom and dad did good!) Karen W.

    • Ramsey Amin DDS says:

      Hello Karen,

      Thank you for your kind words. Yes I do have wonderful parents!!! The family structure is key to society!

      It sounds like you have a condition called peri-implantitis which formed early.

      It sounds like you’re dentist has your best interest in mind. Yes doing a bone graft around the dental implants prior to restoration with the new crowns or bridge is definitely the way to go. Occasionally, bone loss occurs for no apparent reason whatsoever in a healthy patient with an excellent dental implant dentist.

      Titanium allergy is not something that is common whatsoever. It is not commonplace for dentists to check for titanium allergy as it is not even really known if it can truly happen or not. The chemical structure of titanium is not typically seen by our immune system. You can have allergies to other nonprecious metals, but titanium allergy is poorly documented as of 2014. Keep in mind that dental implants have been use since approximately 1965.

      Good luck with everything. Don’t lose hope. This is just some minor bump in the road. Soon enough you will have you’re awesome dental implant teeth and be able to put this all behind you.

      Respectfully,

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

      • Karen W. says:

        Thank you Dr. Amin for your quick and informative response! Your encouragement is greatly appreciated and I will remain more patient in this process of my full-mouth restoration.
        I feel much better!
        Best regards, Karen W.

  154. Sarah says:

    Hi Dr. Amin,

    Thanks for the wonderful blog! I read the entire thing and didn’t quite find an answer yet so here goes! I had an implant and bone graft done on my #36 at the same time 6 weeks ago. I didn’t have any issues with infection but the implant area is still very tender. For example, lightly applying pressure on the nom-implant part of my jaw is fine but any pressure in that area feels like I’m touching a bruise. The graft area also has a little bulb/raised area (I imagine that’s just the 3D nature of a graft) and it is when that area has pressure applied that I’m in discomfort.

    Could you please give me any possible insight as to what my discomfort is indicating, since I am clear for infection? I’m hoping I’m just a slow healer but I’m scared its something worse. Thank you,

    Sarah

    • Ramsey Amin DDS says:

      Hello Sarah,

      Having pain for 6 weeks after having a dental implant bone graft does not sound good. If it was a huge onlay block bone graft, then may be… But still something seems amiss. If this was a bone graft that had the intention of having gum covered over it the entire time and now it is exposed, there is a very good chance that the bone graft is failing or your losing volume of the bone graft.

      If this is a type of bone graft that is purposely left with an exposed membrane, then it may just be slow healing or non-integration of the graft. Some types of guided bone regeneration’s require complete coverage of your jaw with no membrane exposure while others are okay to have small exposure. Some socket bone grafts are okay to have membrane exposure, but I don’t know what type of bone graft you had and what type of material you had also.
      Bone grafting is an art and a science.

      I suggest you see someone who has a lot of experience with this. The raised bulb is likely a fistula starting which is more of a chronic infection than an acute infection –could also be a large particle of the bone graft sticking underneath the gum. I would see your dentist ASAP and have an x-ray taken.

      Ramsey A. Amin, D.D.S.

      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  155. Candice says:

    Hi doctor,
    I had my bone grafting done about six weeke ago and I have extreme sensitivity when I eat especially sweet things, can you tell me how long that will take to stop?

    • Ramsey Amin DDS says:

      Hello Candice,

      Sensitivity to sweets is the sign of a cavity. You likely have a cavity on an adjacent tooth or some very significant root exposure. Sometimes things coincidentally occur in the same area of the mouth. See your dentist ASAP before you end up with a root canal!

      Very respectfully,

      Ramsey Amin DDS

  156. Christina Faith says:

    I found out in May 2014, due to swelling that I found around tooth #15 while flossing that this was not a dental issue, it was the sinus. After getting a CT scan, found a 2CM maxillary cyst, after a lateral biopsy, pathology showed benign. I have since had it removed via endoscopy which found infection and culture showed staph and am currently doing sinus rinses with Mupirocin 2% 1Xd to resolve the staph.

    After the endoscopy, my ENT told me that all went great and now I would just need to extract the culprit (#15 tooth), So I felt like we were almost finished with this process and today when I went to an oral surgeon, he said ” Because there is no bone above #15 that I will have a large hole from mouth to sinus and he would not do the extraction. Such a sad and overwhelming situation, and I really am becoming very fearful of things to come as I also found out that my dental insurance does not cover this, and health insurance does not cover either. Can a person live like that, such a sad time for me. I wish this had been found way sooner as I would have had more of a structure left in my mouth to work with. Any suggestions would be welcomed and appreciated. Thank you.

    • Ramsey Amin DDS says:

      Hello Christina,

      Thank you for sharing your story. I think you should seek another opinion for your extraction. The upper molars like tooth #15 share the same bone with the sinus. That bone is paper thin and is generally not absent, just paper thin. You should be able to see on 3-D scan that there is bone present above tooth #15 which should make this extraction safe and easy. I would definitely suggest a preoperative 3-D scan to know this in advance. There is no way to guarantee this but definitely ways to get more information before you end up with a complication which we call an oral antral fistula which translates into a hole in the sinus.




      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, California

  157. Melissa says:

    Hello Dr Amin
    4 days ago I had a bone graft done in my front theet. The dentist said that he used bone from around my mouth and block bone too. Just behind my front teeth is very swollen, feel like its the bone graft But its just a lump but its very uncomfortable when I touch it with my tong and its been a bit uncomfortable to talk as my tongue has to touch it. Do you think it’s normal or will disappear in few days? He also put a fixed bridge in the front teeth for now as it was what I was using before, he just did a new one , but he said there is enough space for the gums to heal, do you think it will heal even with a fixed bridge covering the gums?
    Appreciate your time to answer all this questions that you answer for everyone ! You are very kind

    • Ramsey Amin DDS says:

      Hi Melissa,

      It sounds like your treatment is going well. Having a fixed temporary bridge over over a bone graft is far better than having a removable bridge over a bone graft. The fixed bridge prevent any pressure from being applied to the bone graft as it heals. In order for a bone graft to heal it needs to have 0 mobility.

      The swelling you have should subside in time. It sounds like you’re undergoing good care. Good luck!

      I hope this helps

      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, California

  158. Laura says:

    My 17 yr old daughter is missing teeth 7 & 10. She had bone grafting done w/bone morphogenic protein 7 weeks ago and anticipate having the implant posts placed in 6-9 months. 19 days post op, one incision line opened & the barrier has been visible since. Rather than the area getting smaller and closing, it has increased in size. I suspect it must be from the growth of bone? The gums are non tender & look healthy. She wears invisalign retainers w/pontics in 7 & 10 started wearing them again @ 3 weeks post op. Could that impact the wound healing?

    • Ramsey Amin DDS says:

      Hi Laura,
      Bone morphogenic protein also called BMP can cause tremendous amount of swelling that rips open incision lines. This can often become a complication. I’m hoping your on antibiotics and have already seen your dentist since this post a few days ago.
      The swelling is not likely bone growth because you typically would not see it enlarge likely that. It could be an infection also. There is a possibility that the retainer pontic’s are touching the area where the teeth use to be and is causing the problem. Make sure to have that checked to be sure there is clearance underneath… Please keep me posted.

      I personally use BMP made from my patient’s own blood rather than commercially available BMP. Your own blood can be processed in such a way to release growth factors such as PDGF. This is a routine procedure in my office that we do every single day for many years. PRP and PRF are excellent enhancers of healing without some of the BMP complications.

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

  159. justice says:

    This website is so helpful! I have been reading it for days. I recently had a lower first molar extracted and bone graft in preparation for an implant. After the first few days I lost a non dissolving stitch holding my gums up. I called the office but my surgeon is away at a conference. In the past five days the gums on the buccal side have split and started to grow under the membrane and have been throbbing. I am particularly worried as I am leaving on vacation this week and fear I may need something done, but not sure what and how serious. Any feedback would be great!

    • justice says:

      I went in to surgeon and he removed the membrane. He said it was not the dissolving kind. Some of the throbbing has gone away, but granules keep coming out and there looks to be a hole in the middle of the graft material. Is this normal? Is bone expected to grow into the hole?

      • Ramsey Amin DDS says:

        Hi Justice,

        Yes, this is sometimes normal— see this post:

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

    • Ramsey Amin DDS says:

      Hi Justice,

      This should help you:

      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, California

  160. john says:

    I had a bone graft in August and I’ve been wearing a temporary flipper. How long would I have to wait to get the implant and will there be a gap temporarily? How long after the implant can I have braces put in?

    • Ramsey Amin DDS says:

      Hi John,

      Braces should ideally be done before having a dental implant. Dental implants cannot move by orthodontics. Once they are in their final resting place, no type of braces can move them.

      A bone graft typically takes 4-6 months to heal before having the dental implant. Ideally the dentist can create your temporary so that there is no gap especially if the dental implant is going to be in the front of your mouth. The dentist can always add and subtract from the temporary flipper.

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

  161. Rudy says:

    Hello Dr. Amin

    lost my front upper tooth due to trauma (Knee to the face). Living in a border town and lacking funds to pay for price, I went to mexico to get an implant placed. Now I spoke to 3 dentists here in the states and they all said I had thin bone.

    I got the implant placed with the promise from my doctor that in 4 months he would place the healing collar. 4 months later when doing the torque test he said the implant slightly moved, wait 2 more months, we both agreed that would be for the best. 2 months later, he takes an xray says he will complete the task but notices in the xray there is black shades, that I would possibly need a bone graft.

    So I go for the collar to be placed, when he uncovers it. I notice he say not good, and he then proceeds to give me a bone graft. He takes pictures of the area and points I have loose threads on my implant. That about 50% is integrated and the other 50% is outside of the bone. We will now wait 6 weeks to see if my body takes in enough bone to then finish the process (place healing collar, molds, etc) if not then remove the implant and start over.

    I have never heard of this (doing a bone graft after the implant has been placed). What are my chances for this bone graft to be successful so my implant wont fail? Any suggestions or advice would be greatly appreciated. I have a picture of the implant with loose threads but the forum wont let me attach the picture. Once again, any advice would mean a lot to me, thanks.

    • Ramsey Amin DDS says:

      Hi Rudy,
      Ugh… I feel your pain. I have seen this same story repeat itself so many times. My practice is in Burbank California which is in Southern California. So of course I have seen many patients who have been treated in Mexico to save money.

      A bone graft can definitely be done after the implant is placed and is sometimes done at a staged two uncovery procedure. Whether this bone graft will be successful is the big question. It sounds like you’re missing a lot of bone. It also sounds like the implant is severely compromised based on what you’re telling me. When it implant moves, it is basically considered a failure.

      My best advice would be to seek a second opinion with a very skilled and experienced dental implant dentist prior to making the final crown.

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

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