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

Exposed bone in mouth after graft
Exposed bone in mouth after graft

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

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

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

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

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

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

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

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

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

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

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

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

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

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

3d scan burbank ramsey amin (4)

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

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

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

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

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

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

  1. I had bone graft put in two days ago. There was some white showing I noticed yesterday. This morning I wake up the sutures are still in place and the white thing I’m pretty sure I swallowed in my sleep. Did I swallow the bone graft? Should I be concerned ? What would happen if I swallowed the bone graft with that white thing ? The white thing appeared to be material

  2. I had ridge preservation #14 around 6 weeks. Last 4 days I still see white stuff but today I noticed all the white stuff is gone just have a little little piece still hang in there and on that surgery area is red. Is it start to healing or something is not normal? please advise.

  3. Hello: so I had a tooth extraction and bone graft holder placed to eventually put in an implant on my upper #7 in the front. I have a temporary tooth (literally like one “denture” piece) I’m curious if I got this on Tuesday and it’s Friday…. can I sleep without the false tooth in? Or does it risk infection because it’s more exposed?

  4. I have a serious situation and need to know if an extraction of a wisdom tooth upper right side back in June be the cause of a severe headache/migraine that has not gone away with medication of any kind? I am a migraine sufferer but only get maybe a half dozen or less a year. since having tooth pulled I have had 2 or 3 a week with each one being more painful than the last. Today I noticed bone spurs coming through and my headache has subsided to a tolerable level. Is all the headache from bone spurs? I have tried all sorts of medication over the past 2 weeks, been to urgent care and the hospital for the headache, I never once thought it was tooth related as other tooth extraction never caused a headache. Bone spurs yes but never a headache. Any help or advice would be greatly appreciated. Thank you Joe

    1. Not likely related….they happen to the best of us…even me and my wife get them. I assume you are between 30- 50 years old as this is more common.

  5. I also meant to ask, when can regular diet, solids, chips, chicken etc. Start after this is done? once again it was done on Wed. of last week.

  6. Hi,

    I had a broken post and core crown, with a root canal, that was removed on Wednesday of last week with bone grafting put in in order to put an implant in later this year. It is now Monday. I can feel the sutures starting to hang and that doesn’t bother me. But I am still feeling small flecks of the graft material/bone in my mouth. Several a day. Is this still normal? Plus if I press against the upper jaw line (on the outside) it is tender, there is no pain on a regular basis, almost feels like something it stuck between my teeth.. I am assuming that is just the feeling of a tooth not being there. Is all of this normal? I have an Amoxicillin prescription and it hasn’t bled or oozed anything since the day of the surgery. I cannot see what the gum looks like, but I can see a corner of the membrane sticking out against the tooth next to it, they are removing that in 3 weeks.

    1. You shouldn’t be feeling small flecks of bone coming out…but it is within range of normal depending on many factors such as skill of your surgeon and difficulty of your procedure. Keep it really clean and I assume you are rinsing with chlorhexidine as well. Antibiotics are generally needed for these types of procedures so make sure you take it

  7. Hello! I had all third molars removed along with #3. #3 was an RCT treated tooth that ended up failing and needed to be extracted. My Dr. and I decided to do bone grafting at the same time as extraction, 1 week and 1 Day ago. Today, I noticed threads hanging around my tongue and realized that the non dissolvable sutures are falling out of the socket. As my office is not opened on weekends, I’m concerned that this might be an issue. Should I be concerned?

  8. I had a tooth extraction with bone graft on a lower molar 10 days ago. The scab came off so I can see the bone. I also notice some blood when I brush my teeth. I am avoiding this area while brushing. Is this normal? ank

    Thank you for your time.

  9. I had implants and bone grafts done front upper teeth #7 &10 almost a year ago and went back today to move forward with the procedure. My dentist said there was infection and he would need to go in and look at it and maybe open it up and clean it out. Well he did and did another bone graft on both implants. But when I got home and looked at my gums he shaved them way down. my gums are pretty much gone…. Will my gums grow back? Why did he shave them all the way down? Is this normal?

    1. seems odd….ask your doctor the rationale and process. I’m sure there is good reason for doing what they did!

      1. Hi Dr. Amin

        The info you provide on the web has been very helpful. Thank you. I got a bone graft in #7 but the dentist didn’t give me a syringe to clean it as I believe she should’ve. I tried cleaning it the best I could but didn’t want to brush the area too much for fear I would detach stitches. It got infected from food (sour taste and smelled like a tonsil stone) so I had to go back in. They cleaned it with a syringe pretty thoroughly and it was better, but when they cleaned it it opened up the wound a bit and pushed the gums open. The stitching was still in tact and I was hoping had enough life left to pull it shut. Three days later the stitching and what was left of the membrane came out. No bone is falling out and everything seems ok except the gums aren’t covering over the bone graft. There is a half of a centimeter gap. Will the gums eventually grow over it? Thank you for your time.

        1. Thank you for taking a look at my information. Rinsing with a syringe would be the worst thing possible because it causes more disruption. There is wide variation in technique in experience level with dentists doing bone grafting. If it is a critical defect then consideration should be done to draw your own blood in use it to patch the hole closed. See link provided.

          If it is not a critical defect eventually it will close but with lower bone density and lower bone volume. Each case in your genetics is so unique. Usually they work out in noncritical defects.

    2. seems odd….ask your doctor the rationale and process. I’m sure there is good reason for doing what they did! !

  10. I had a synthetic bone graph approximately 23 years ago. All has been fine. I can see a small fleck of the “bone” coming out of my gum. It’s not hurting or really bothering me. Should I be concerned?

      1. Thanks so much for the reply! After seeing the dentist, he said I have a cavity below the gum line. I have been given options, A. Root lengthening and have cavity filled (on the tooth that had a bone graph due to cleft paler) B. Removal and implant into the synthetic bone graph, c. Have a permanent bridge. I have no idea which is best….

    1. Dr. Ramsey Amin,

      I had all my upper teeth removed from teeth being bad and severe infection behind tooth 9,10,11. The infection ate up 3cc of bone behind teeth. The Dentist cleaned out all sockets,debrid area,disinfected area and bone graphed with human bone (no DHA) L PRF made from your own blood platelet concentrate. The dentist bone graphed immediately after cleaning out the infection. Since this is a large area, should he have waited to graphed later after infection healed? The Dentist prescribed Clindamycin 300mgs 15 pills for only 5 days. Should I be taking more antibiotics since area is so large and will take longer to heal? It has been a little over three weeks with no pain. Would I know or feel if I have a infection in the large area? or would it be only seen from x-ray? Thank you.

    2. Dear Dr. Amin, I certainly wish you were closer! After a failed root cana, I developed a fistula, I had an apico, my oral surgeon gave this a 50/50 chance of working. 5 days ago I had the tooth pulled and a bone graft put in. This is tooth # 11. I had very little to no pain the first few days now pain is returning and almost feels like when the pain I had after the apico. I am on antibiotics. Should I have the bone graft removed and redone at a later time? Do you think the area needs more time to heal? Appreciate your thoughts.

  11. Dear Dr Amin.
    I am at my witts end. Hopefully can shed some light or point me in right direction as to next step. Its a long term issue after implant/infection/removal 2nd bone graft. Dec 2016 i had an implant in mandibula. Then in april 2017 the implant was removed and debrided because of infection. One year later (now) I STILL have a lump on my jaw that is tender and swollen to the point of fluid pouching in my neck.
    Ive been to so many dentists, implant specialists and maxilofacial surgeons. NO one can tell me what is this lump on my mandible and they do not know why its swollen. Ive had 4 different 3d scans, one with injected contrast. I have mri’s. Ive been told five different ways its NOT an infection, its not a tumor. Ive travelled to 3 different countries to assess it. (I live in a small town so im thinking larger city, more advanced country might be a good idea for more wisdom). So why is it swollen even to the point of swelling in my neck? Ive been put on meds for neuropathic pain, muscle relaxants (cuz im a clencher). To no avail. During the last visit to the maxilofacial guy he noticed one difference at the site of the problem. He said it appears that where i had the surgery of implant removal and huge debridement, followed by 2nd bone graft, shows increased bone density. Like a callous during broken bone healing. If so why is this causing swelling in my neck and why is the lump not disapating after 1 year ??? What can i do about it ? Have you seen this kind of long term problem before and how does it resolve? True you probably can not assess on website but if you could point me in right direction for next step I would be grateful.

    1. Did all of this occur from just one tooth… Or was it several teeth?

      I would suggest you are probably seen at a dental school by an oral pathologist. They may be able to shed some light on this extremely unusual situation.

      1. Wow truly amazing that you replied and so fast! Thank you so much.
        All this is due to one tooth. 1st Molar on mandibula, left side.
        Ok I like the idea, an oral pathologist.
        How do I find oral pathologist ?
        I am willing to do whatever.

        1. Oral pathology is a Department in every dental school. There are some private oral pathologists. Just use Google!

          1. What did Jen find? I am having the same problem with swelling in neck and lump near grafting g site on lower mandible? Did the dental pathologist resolve his issues! I did not advance to implant! Just extraction of one tooth and bone grafting following abscess. Blood work several times shows no infection!

        2. Oral pathology is a Department in every dental school. There are some private oral pathologists. Just use Google!!

  12. Dear Dr. Amin,

    I had a straightforward sinus lift, bone graft and implant procedure approximately 3 weeks ago. Took 2 kinds of antibiotics, painkillers etc. Had the usual swelling/bruising, and all seemed to heal well- no nasal discharge, no bleeding. However, since the day of the surgery I have had a headache/ jaw ache on the side of the surgery (right upper molar- #6 I believe) and the pain has never eased or disappeared. I am getting to the point of wanting a removal of all of it as I cannot take the constant toothache/headache any more. Painkillers do not work. I don’t believe I have an infection as I have no fever, no discharge. The gum has healed beautifully. Could it be possible I am allergic to the implant/ bone grafting material? Can the bone grafting material be successfully removed as can the implant? I am due to see my dentist this week. I know headaches are not usually linked to implant surgery, but I am not a migraine/headache sufferer ordinarily and this started the day of the implant surgery and is only on the side of the implant- it is too coincidental. I also obviously don’t have the crown yet (I have to wait 9 months) so it cannot be a TMJ problem as the teeth still align as before (with the gap) I have suffered with TMJ for years and wear upper and lower retainers, which completely relieve all my TMJ symptoms so I know it’s not my TMJ suddenly starting up. I am sure that my pain is a direct result of the implant. What are your thoughts??

    1. Question — Could it be possible I am allergic to the implant/ bone grafting material?
      Answer — super unlikely!

      Question —Can the bone grafting material be successfully removed as can the implant?
      Answer –Yes

      A postoperative 3-D x-ray scan is indicated. The drainage passages of your sinus should be evaluated to make sure they are open. The scan will also tell if any graft has migrated from its original position.

      The sinus bone graft is a very predictable procedure with an experienced dentist. Of course the diagnosis and treatment plan need to be in line with your x-ray and clinical situations.

    2. Question — Could it be possible I am allergic to the implant/ bone grafting material?
      Answer — super unlikely!

      Question —Can the bone grafting material be successfully removed as can the implant?
      Answer –Yes

      A postoperative 3-D x-ray scan is indicated. The drainage passages of your sinus should be evaluated to make sure they are open. The scan will also tell if any graft has migrated from its original position..

      The sinus bone graft is a very predictable procedure with an experienced dentist. Of course the diagnosis and treatment plan need to be in line with your x-ray and clinical situations.

    3. Question — Could it be possible I am allergic to the implant/ bone grafting material?
      Answer — super unlikely!

      Question —Can the bone grafting material be successfully removed as can the implant?
      Answer –Yes

      A postoperative 3-D x-ray scan is indicated. The drainage passages of your sinus should be evaluated to make sure they are open. The scan will also tell if any graft has migrated from its original position..

      The sinus bone graft is a very predictable procedure with an experienced dentist. Of course the diagnosis and treatment plan need to be in line with your x-ray and clinical situations.,

  13. hi there, doctor. on tuesday, which was a couple of days ago. I had a bone graft or grafting to preserve my bridge because it got infected when i had a bone graft and and a dental implant. so during the grafting procedure they removed the dental implants and now the wound didn’t completely close and i see a piece of cotton that they left in there. does this mean that my gums are thinning and that i need a gum graft or what?

    1. Cotton???!!! There should be no cost and left in your mouth beyond the first few hours after the procedure. You are probably looking at some sort of biomaterial bone substitute that is exposed.

      You may in fact need a gum graft or additional bone grafting but wait at least a month or 2 to see how the area matures. Each situation is unique of course. Good luck

      1. I had a bone graft on my right lower last tooth 4 months ago in order to have an implant placed. Now I have a piece of bone sticking out on the tongue side of my gums. Its swollen and painful and my dentist can’t see for for 3 weeks, any suggestions?

        1. 3 weeks? A basic follow is needed before then. Ask to wait around and be flexible…hopefully they can take a look at you way before then

  14. I am 54, and had 1 remaining wisdom tooth (#32) that the surgeon refused to remove many years ago. My dentist recommended that I try to have it removed since it was shifting and pushing against the next molar. The surgeon did a coronectomy with a bone graft 9 days ago. After the second day, I started having severe pain in the jaw area. I have a large hematoma that is very sore in the area of the local anesthesia, plus I feel like I’m having some muscle spasm pain as well. I also have a weird taste coming from the extraction area, and keep getting small pieces of the graft material in my mouth.

    I did not fill my pain med script, nor the antibiotic script. I have a high pain tolerance, and don’t believe in taking antibiotics unless I need them. I have been using essential oils for pain and infection prevention. The pain is excruciating, but the EOs work very well for a few hours. After 6 days, I went beck to see the Dr because I felt like the level of pain seemed abnormal. He looked at it and assured me that everything I was experiencing was normal considering my age, so I went home relieved. Now it has been 9 days, and my pain level has not changed. Shouldn’t the pain gradually recede? I fear he just thought I was being a pansy, and didn’t take me seriously.

    Does this sound normal to you? – Thanks! –

    1. You definitely have an infection. Antibiotics are a requirement when a bone graft from a source that is not your own body is used. We didn’t need antibiotics in the past when these types of procedures were not available… The body could just heal itself. You are having very advanced procedures done.

      Typically on the coronectomy procedures I do I never place a bone graft because they tend to heal very slowly but not to the degree that you’re describing. Typically I would just use L PRF made from your own blood platelet concentrate.

    2. You definitely have an infection. Antibiotics are a requirement when a bone graft from a source that is not your own body is used. We didn’t need antibiotics in the past when these types of procedures were not available… The body could just heal itself.

      Typically on the coronectomy procedures I do I never place a bone graft because they tend to heal very slowly but not to the degree that you’re describing. Typically I would just use L PRF made from your own blood platelet concentrate.

  15. I had severe gum recession on canine tooth after implant to replace a premolar next to it. This was done after opening space while on orthodontic treatment (I had both premolar teeth on the right extracted as a child as the canine tooth was impacted). I had malocclusion due to the teeth shifting following that early extraction. To correct the gum recession I had a gum graft. The graft was extracted from the palate around the right molar tooth. The gum never grew back in that area due to loss of bone that had not been detected. It is at least 50% gum recession. The tooth is not mobile but the root is exposed on the palate side and I am very worried with such a severe recession. Would a bone graft be an option to correct this? Is there any chance of recovering the lost bone and gum? What is the prognosis for this tooth?

    1. ugh…. Based on your very descriptive description it sounds bad. Bone grafts can help rebuild bone around the teeth as long as it is more of an angular defect. If bone and gum is missing 360° around the entire tooth there is not much hope for grafting gum or bone. I’m sorry for the bad news but sounds like this will be difficult reconstruction. Sometimes these teeth even need to be extracted and replaced as well. Typically there is some sort of pre-existing bone loss on the canine for this to have happened.

      1. I had an extraction of #3 due to failed root canals and fracture. They did a bone graft. I am on day 5 Post op. They prescribed amoxicillin and 600 ibuprofen. I took the ibuprofen as directed for the first two days after… I get ulcers easily and usually try to stay away from NSAIDs. On night 3 I woke up with horrible stomach pain so I immediately stopped the Ibuprofen. Particles of bone continue to fall out. There’s an odor… and the pain has increase. I also noticed bleeding in hole. I’m afraid too much has fallen out. I called today and they said it was normal. But how much is normal. What else for pain would you advise.

  16. Hello… I recently had a double extraction of (2) molars. In addition, I had a synthetic bone graph. All seems to be healing properly, however it’s week 3 and I noticed a really hard and sharp area protruding from the area. It’s painless but awkward. I know the body will try to rid itself of what doesn’t belong but it’s pretty sizable (it feels like bone pushing through)😱….please advise. The gum has not ruptured at all!

    1. Give it more time. 3 weeks is not enough. If it continues to stay there, perhaps at the time of implant placement a can be filed down to be smooth and level with the rest of your jawbone.

  17. Hello,

    I have been reading through many of your questions and answers and I have to say I love how responsive and informative you are to everyone! I feel as a patient we should have a thorough understanding of this procedure prior to consent, and you seem to do a great job at that as well as answering questions or concerns.

    That said, i have a concern myself currently. I had to have tooth #30 removed on March 29th. The tooth had been through 2 root canals approx 5 years ago, it started causing me increasing pain over the last few months and I found out March 22 that it had cracked and was abscessed in the bone beneath this causing the pain. I chose to have the tooth removed a week later after being on Oral Clindamycin (PCN allergy) 300mg QID for 7 days.

    Post extraction and bone graft I have been in an INTENSE amount of pain. The swelling in the area was so much that the sutures holding the gums back together pulled through the Gum. They put me on 150mg of CLINDA QID for a week post extraction and when I returned for the increasing pain (I can’t even eat) I was told it was normal and given stronger Norco.

    April 11th, i notices that there is a small hole on the inner lining of the gum (medial toward my tongue) draining yellow pus. It has tasted absolutely horrid !! Sour and wakes me up at night to spit it out. I returned today for suture removal (which had already torn out) and was told that the hole and drainage are all a normal part of the healing process. Additionally i am still in a TON of pain.

    I am looking for a second thought/opinion on what could be going on. I think that the abscess is still present in my bone from the prior infection, it’s not clearing up and is causing more pain. I, however, am not a dentist or an oral surgeon so I guess he could be correct and i could be over worried as well. Either way, the pain is the worst,

    Thank you.

    1. YIKES!! 150mg of CLINDA QID is not enough….300mg 3 or 4 times a day is in order to treat a bad infection. I am assuming you are allergic to penicillin. Please read this post on antibiotics. Often times clindamycin is a poor choice. Sometimes you can combine metronidazole to treat this problem. This type of pain is not normal. A culture and sensitivity would be in order.

      I hope you are doing better now. I would see an allergist to be certain that you are penicillin allergic. Most patients are not even though they think they are. Some people can have cross-reactivity with cephalosporins but most the time they don’t. There are a lot of other options!

      1. Thank you for replying !!! I ended up going to a different endodontist who put me on my third round of Clindamycin he prescribed the 300mg QID and it helps to relive the pain some, but not all of the way. I am able to tolerate the pain, yet when i am chewing it hurts so deep in the bone it is unbearable at times. I just finished that 7 day course and it already is beginning to get worse (pain wise). I also lost a
        Ton of the bone particulate through the membrane about 4 days ago, it just kept coming out like my body was pushing it out. The area is still swollen as well. I am 3 weeks post surgery now. I had an anaphylactic reaction to PCN when I was very young. I would however be willing to see an allergist or take flagyl if that works. What would the dosing be for the flagyl ? Thank you! Do you think that it is an infection that just is not clearing out of the area?? I know it’s bard to assess without seeing but I’m at such a loss for why it hurts so much.

        1. X-rays are needed to make sure the graft is properly placed. If pain has been longer than 2-3 weeks the graft should be removed.

          Flagyl 500 tiD with probiotics

          1. Thank you so much!!! I will see what I can get when I see the new endodontist on Thursday.

  18. I recently got a tooth extracted and bone graft done and am worried that the bone graft is possibly loose or not properly attached. When I look at the spot where the graft is I can see the material used is exposed. I read here that it is common to see the bine graft for the initial healing process and possibly slightly afterwords, but when I very lightly apply a little pressure to the graft with my finger it seems as though it moves slightly. It has been 3 days since I had the procedure done, but right after the procedure I was trying to place a new gauze pad to soak up the blood until a clot formed and heard some squeaking sounds as I was trying to get the pad up in between my teeth. I called my dentist and they said it was normal to hear a little squeaking as there was probably blood between my other teeth and the graft site. Should I return to my dentist and see if my graft is not in properly, or is it somewhat Normal for the graft to move slightly if pressure is applied?

      1. Hello I had some of my bone show and got it sanded down, but now after a few days of feeling better it looks like More of the bone has started to show more once was a small white spot now a longer and bigger white showing. Is that normal to do while it heals. Thanks

  19. Hi Dr.Amin

    I had a bone graft and gum graft at the same time(#9,#10)a year and half ago. Recently, I saw a little white spot that looks like a puss so I went to see my doctor, he took a crown out and told me “its not a big deal”that it is a bone particle, my body is pushing away. He took it out and it was gone for few days. but now it is showing and getting bigger. Im worried that its gonna come out from a gum since my gum right now is so thin:(

    Is this something I should worry about since my graft was a year and half ago???or is this healing process?

    and if it comes out, what can doctor do???

    1. It is probably a surface particle that never integrated. This is not totally common but is within the range of normal. Certain people use the graft materials that are not alive and your body cannot turn it into your own bone. Sometimes this is beneficial and sometimes it can cause particles to come out later on.

      Have an x-ray done and remove any remaining particles. Hopefully this is it and does not continue

  20. I had two teeth extracted 12 days ago on the bottom one on left and one on right. The one on the left was healing great then re-opened after eating a sandwhich. I went to the dentist for a follow up 6 days ago they said food had got stuck in there and I should be fine once they cleaned it and they gave me a syringe to take home . When I look at the holes they look the same as they did 3 days ago. It’s been almost 14 days now. Is this normal for healing ? The dentist said mine is going to take a few months to heal. I also had socket grafting done. It does not hurt but there is just some brownish buildup and still a large hole on both. The one on the right side is bigger.

    1. It also seems like they start healing but as soon as eat something even if it’s soft they start re-opening. Then close back up after a few hours .

    2. Sounds a bit strange. If you don’t have pain it is very likely not is healing just fine. Go in for another follow up to be checked.

  21. Hey Dr. Amin, I just had tooth #5 extracted and it’s been 4 days now. However, my dentist said that a bone graft isn’t needed. I go back for a follow up at the 2 week mark and implants at 4 month mark. Will I be okay without a bone graft? I don’t want things to shift or lose bone. He told me that some studies have shown that bone grafting isn’t as effective as some people think and no need for me to waste my money. Is this all accurate? I just want to know if I will be okay without it. Thanks! I also posted this message yesterday but it got removed for some reason.

    1. Arin…every dentist has a different level of expertise, judgment and experience. Unless you are one of the rare people that just have a ton of extra bone, not having the bone graft will likely lead to a slight depression on the outside of the tooth. For some people this looks very noticeable as a tooth that is slanted. #5 in the American numbering system is quite visible in the smile on the upper right. Not all extractions need bone grafting but most single teeth implants do. Some dentists (and patients) have higher standards than others as well.

      There are times when the absence of a socket graft causes major issues. All the bone resorbs completely requiring a much larger bone graft to correct the area.

      1. Thanks for your reply Dr. Amin. I was also curious why I didn’t just get an implant the same day. It is pretty hard not being able to smile because of the missing tooth. Would I be able to come see you and get that done with you? It has been 10 days now since my extraction without bone graft.

    2. Arin…every dentist has a different level of expertise, judgment and experience. Unless you are one of the rare people that just have a ton of extra bone, not having the bone graft will likely lead to a slight depression on the outside of the tooth. For some people this looks very noticeable as a tooth that is slanted. #5 in the American numbering system is quite visible in the smile on the upper right. Not all extractions need bone grafting but most single teeth implants do. Some dentists (and patients) have higher standards than others as well.

      There are times when the absence of a socket graft causes major issues. All the bone resorbs completely requiring a much larger bone graft to correct the area..

  22. I was recommended an extraction procedure for Molar #18 with a cadaver bone graft to keep the bone strong in that area. I was surprised that the only option mentioned was cadaver (allografts), with no mention of synthetic materials by the doctor. I understand that donor bone is thoroughly disinfected, but aren’t there risks of immune reactions? I have an immune condition called Selective IGA Deficiency, which is harmless but can be a risk factor in blood transfusions, for example, if I were to ever get one. What if the material is rejected by the body, or causes cancers or Lyme disease? I’ve read reports of people getting mysterious diseases several years after processing cadaver bone grafts. Why wouldn’t synthetic materials be recommended to patients?

  23. Hello! I had an upper molar extracted a little over a week ago with bone grafting. Everything is happening as Os said it would but no one warned me of the smell and taste coming from the hole. I have excellent oral hygiene but this is grossing me out! Is a smell normal after 10 days?

  24. Hi there,
    I had bone graft and implants on my front teeth 5 months ago. But still I see white particles coming out of my gums..
    Is it normal.? Given that it is already 5 months.

      1. How are they removed? I also had an implant put in about 6 months ago and I have a pimple on my gums directly where the implant is. I had a tooth extraction (which was infected) and had antibiotics and bone grafting, after 4 months I had the tooth screwed into the implant.

  25. Hello sir I had an extraction with a bone graft done for one of my fractured molars I accidentally punctured the extraction site and the membrane is no longer covering the cadaver bone in my socket as well as the sutures are not holding my gum closed anymore. I can clearly see the bone particles inside and the dental office is closed for 2 days and they don’t even have a dental emergency number what should I do? Will this mess everything up?

    1. Jeez….no emergency phone number contact? That should be reason enough to have treatment done elsewhere. You need to be able to count on your providers when you need them. You need to be seen on Monday.
      here some information about membranes
      Likely things will be okay but you will not generate as much bone and density may be low after at all heals…. Good luck

    2. Jeez….no emergency phone number contact? That should be reason enough to have treatment done elsewhere. You need to be able to count on your providers when you need them. You need to be seen on Monday.
      here some information about membranes
      Likely things will be okay but you will not generate as much bone and density may be low after at all heals…. Good luck.

      1. I had two back upper teeth pulled and bone graft done a year ago and I haven’t healed! I’m laying here in bed crying cause my face is so swollen into my eye and my back hurts, I’m swelling in my legs, and running fever.. The doctor that did this won’t return my calls and I don’t have any money to go to another dentist! I had to pay him 5000 dollars up front. I feel like I got butchered and shoved aside 😥

        1. Nothing about this sounds normal. If you truly have pain a year later than you have a failed graft/infected graft that needs to be removed. In 20 years of doing this I have never had a patient that has had this occur. I would not abandon my patients that has this type of issue. Try to call them again and get an appointment to be seen. Sugar always works better than vinegar if you catch my drift.

    3. Jeez….no emergency phone number contact? That should be reason enough to have treatment done elsewhere. You need to be able to count on your providers when you need them. You need to be seen on Monday.
      here some information about membranes
      Likely things will be okay but you will not generate as much bone and density may be low after at all heals…. Good luck..

  26. Dr. Amin- Can you tell me if a hard lump which forms at the place where an extracted tooth’s roots would have been (w/ bone graft) can be normal? I had #26 extracted almost a year ago, it was a tooth with root canal (RC done over 20 yrs ago) that got infected. I noticed after the tooth was extracted and bone grafted, that a hard but painless bump formed in the gums where the roots would have been- lower gum, where it meets the mouth. I explained my concerns to my oral surgeon but he said he saw nothing wrong and said it was just my chin bone. However he was basing this off a panoramic xray. I just had an implant inserted 2 weeks ago and so now in the healing stage for that, but was wondering if this lump should be anything I should worry about, or does this usually happen after bone grafting is done?

    1. it is not likely anything to worry about….but..I would open the gum to expose to make sure….it can even be shaved down if needed.

  27. I had my bottom two molars pulled on my right side, one was cracked and infected and the other in front of it had a hole/cavity in it on the side. After taking a few rounds of antibiotics and getting my gum lanced I had the teeth removed. The oral surgeon added a bone graft so I can get implants later, prescribed antibiotics (amoxicillin). Still a few days later there is still a bump on my what feels to be gum/jaw where the original infected tooth and abscess was. Should this go away with time? Thank you!

    1. It will likely go away. It is still very early. Bone remodeling takes several weeks for all the lumps and bumps smooth out

  28. Hello Sir,

    I had an extraction due to a fracture tooth – failed root canal. My Dr. told me that fragments of bone left behind after the extraction are common and the body/gums will reject these and they will simply “pluck them out” as they surface. Is this true?


    1. Your wording is a bit strange…I’m not sure I understand.

      Did you have a bone graft or an extraction without a bone graft? If you had a bone graft and it is a basic type of socket graft… Some dentists have a technique where superficial particles are plucked out. If you did not have a bone graft and you are having pieces of your own bone come out this is not very common but does happen.

      I prefer to use non-dissolvable membranes for most socket grafts to prevent any bone loss at all and to ensure a high density bone reconstruction.

      1. Hello , I had a teeth extraction about 10 hours ago and I have checked the hole and can see bone peeking through, I’m really hoping it’s not a dry socket ! How do I know for sure ? & no there is no pain.

        1. too early to even consider dry socket which generally happens 3-5 days out. Also it occurs 99% of the time on the lower wisdom tooth and not on any other teeth in the mouth

        2. too early to even consider dry socket which generally happens 3-5 days out. Also it occurs 99% of the time on the lower wisdom tooth and not on any other teeth in the mouth.

  29. Hi!!

    I had two failed implants on the lower jaw, back left that were removed two weeks ago and then had a bone graft the same day. It has been two weeks and I have a pretty big hole and the gum has not healed over the site. I think I can see the graft particles. Food gets stuck so I clean it regularly with salt water and a syringe my doctor gave me. Is this all normal? I’m not really in pain anymore.

    1. Normal… It is within the range of normal but when you have implant failure you really want the bone to grow back as good as possible. I’m sorry have to go through all of this. Why you think your implants failed?

  30. Hi! I had an extraction and bone graft on #19 a week and a half ago. I have sutures and membrane still in place. Last night as I went to brush my teeth, I forgot about the area and brushed over as normal. I felt a little pain after but no bleeding. Is it possible I messed something up? It looks like my gum is over the graft site but i’m not sure if this is how it was prior. I have a follow up in two weeks but was wondering if I should move it up? Thank you for your insightful replies.

  31. Hello, 3 weeks ago I had a coronectomy with bone graft. Pain is just now getting to a point where I can treat with just OTC IBU. I had the stiches removed today, and when I look in there I can see the bone graft materials exposed. Is this normal? Will my gums eventually cover the material? There are still bits of it coming out everyday…probably the size of a pencil tip maybe twice a day.

    1. I am not a fan of bone grafting wisdom teeth sockets. They typically healed very slow. What you are describing is normal. It will likely take much longer to heal than a typical bone graft.

  32. I had all 28 teeth extracted and 9 bone grafts and immediate dentures put on with in 2 hours after the dentures were on I could not handle the pain.After taking norco I was sick to my stomach started to gag on this big denture in my mouth gagging them out and throwing up black stuff I was supposed to leave them on for 24 hours but only lasted two hours. Im day 6 still throbbing. Can’t take pain meds make me sick. I take liquid tylenol instead. Is it normal after 6 days to still have throbbing pain. I have taken antibiotics and went back to dentist they said everything looks good.

    1. Yikes….there are great techniques for painless recoveries using ibuprofen and tylenol alone. Even my zygomatic implant patients don’t need Norco. It is a combination of IV sedation, low dose steriods, long acting special novcaines, sterile techniqe, PRP-PRF to make it happen. It sounds like you had none of this so your pain is intense. I assume you are still on an antibiotic at day 6?
      Best advice would be to call your dentist at this point….sorry.

      1. How long till throbbing pain goes away without any medication. I just finished my antibiotics today but still have discomforts and pieces of the string suture are hanging in my mouth. I was also wondering how long my dissolving sutures will dissolve??

        1. Most sutures and membranes for this technique in 2017 should not be dissolvable IF this is a basic socket graft. Other types of grafts and oral surgery are fine with dissolvable suture that takes 5-10 days to go away. Go see your DDS asap if you still have that much pain and 7 days have past.

        2. Most sutures and membranes for this technique in 2017 should not be dissolvable IF this is a basic socket graft. Other types of grafts and oral surgery are fine with dissolvable suture that takes 5-10 days to go away. Go see your DDS asap if you still have that much pain and 7 days have past..

  33. I had a dental bone graft procedure done just over a month ago. I was born without the teeth on either side of my top front teeth, so I had grafts so that I can get implants in six months. I’m very sad though, because my face is definitely different, and is not as attractive as before. I’m only 18, and I don’t look like myself anymore. A very close, nice, honest person has affirmed that I look different. I thought it was swelling at first, but it’s been long enough and feels hard enough so that I know it’s not. I think he put too much bone in. Is there any way to remove the unnecessary bone? Perhaps when or after they insert the metal screws? I need help :'( I don’t want my appearance to be different for the rest of my life.

  34. I had a dental bone graft procedure done just over a month ago. I was born without the teeth on either side of my top front teeth, so I had grafts so that I can get implants in six months. I’m very sad though, because my face is definitely different, and is not as attractive as before. I’m only 18, and I don’t look like myself anymore. A very close, nice, honest person has affirmed that I look different. I thought it was swelling at first, but it’s been long enough and feels hard enough so that I know it’s not. I think he put too much bone in. Is there any way to remove the unnecessary bone? Perhaps when or after they surgically insert the metal screws? I need help :'( I dont want my appearance to be different for the rest of my life.

    1. hmmm….adding bone is not always needed for a GREAT and long lasting result. I assume you had a sinus graft. Perhaps consider bone leveling and a prettau dental implant bridge for full lip support. You might want to ‘consider’ removing the rest of the teeth if you truly only have for upper teeth. This will give you the advantage of cross arch dental implant stabilization which is critical for the long-term to avoid implant failure. Because of your young age being treated by an expert and looking at things from a 40 year standpoint would be my approach. Good luck. Having more bone is always better than having less bone!

  35. Dr.Amin, sir, about 1 month ago i had all my upper teeth pulled us 1 bottom tooth pulled all at same time. I was given iv and dont remember anything. But 1 week after the extractions the bottom gum near the extraction seemed like it swelled and had a puss pocket come to surface. I went back to Dentist that done tbe procedure. She said its not puss and that it is an exposed jawbone. She numbed the area around the exposed jawbone and made incisions to make it bleed. She said hopefully tbat will promote healing and the gum may cover back over the bone. To clarify, there us no tooth there anymore and she said it is not a bone fragment. Question is, do you think there is a gum graft in my future. It was a hard thing just to go see the Dentist in first place. I am scared i have to go thru another surgery.

    1. This is called wound dehiscence. It will take some time for the bone to cover with gums. I do not suggest that you try to suture this area. Do not wear any sort of removable temporary device over top of it. It may take 4-6 weeks to cover. Be sure to use 0.12% chlorhexidine rinses on a daily basis while it heals. Antibiotics would be suggested.

    2. This is called wound dehiscence.. It will take some time for the bone to cover with gums. I do not suggest that you try to suture this area. Do not wear any sort of removable temporary device over top of it. It may take 4-6 weeks to cover. Be sure to use 0.12% chlorhexidine rinses on a daily basis while it heals. Antibiotics would be suggested.

  36. I had a block bone graph done on my two upper molars on Aug.3. I was born without those two teeth, so bone was never there. Two weeks after the procedure, I developed an infection on my right side. My Oral Surgeon prescribed a second round of antibiotics, which cleared it up. 3 days ago I started having pain again and noticed that the bone is showing through the gums on the same side. I called my surgeon to get in to see him ASAP. What will the procedure be to remove/repair it? Will I need anesthesia again, or a local anesthetic? My mouth has not completely healed from the surgery and I am worried about the procedure/steps he will do to repair it causing even more pain that what I am currently experiencing. The office receptionist states that I do not need to have anyone accompany me to the office inferring that no anesthesia will be used, but I am assuming something will have to be used to numb the area correct?

    1. You can find more information on block bone grafting here. The main thing is that you cannot be wearing a temporary that touches the gum at all during the healing duration! You must have a type of temporary that can be cleared from touching or does not touch at all. If no one is driving you home than you are not being sedated but I’m sure you will have to get numb. They will need to do likely a debridement and remove part of the bone graft if it is showing.

  37. I didn’t have bone grafts done but I had to have all my top teeth pulled about 3 weeks ago and I have been to the dentist last week and he had to grind the bone down on one area and this week it is really swollen and sore with a pus sack on it and the bone is coming through again and now on the other side the bone is coming through he said it’s not fragments and he can’t pull them out it has to be ground down and I have pain in all my top gum area it’s a throbbing pain like a tooth ache but I have no teeth there and was told I needed to see an oral surgeon so I can get dentures because I need a fronectomy or something like that I can’t really read the Dr.s handwriting on the referral but no oral surgeon will touch me because of liabilitly issues so now I can’t get dentures is all of this normal and should I have the bone sharp and protruding over and over again and pain.

    1. What’s the liability issue. All of this should be very easy and taken care of in the office that did the extractions.

      1. they don’t do it there and they referred me to an oral surgeon and they won’t touch me so I didn’t know if this is normal and the dentist that did the extractions just had to open up 2 spots again and grind the bone down and clean it out because they were infected in your opinion how long would it take to do x-rays, numbing, taking out 11 teeth
        and stitching it up

  38. Hi!
    So about 3 weeks ago I had my wisdom teeth pulled out but he also pulled out my first molar on the bottom left side. He gave me the boning inside of the gum so my teeth wouldn’t shift and stitched it back together. The pain is finally gone, but he gave me dissolvable stitches and they dissolved early last week, so two weeks after the procedure. Now, I have a hole where my tooth was where the gums didn’t close up all the way and they are covering over the edges but there there is a line down the middle that is still exposed. The gums flap on the top where they aren’t attached. Is it normal for there to still be a space? How long should that take to close up completely? Is that something I should worry about not closing all the way?

    1. It sounds pretty normal. The gum will flatten out in a few months. Of course I don’t know exactly what was used or how it was done but I would not be overly concerned about it. 🙂

  39. Hi Dr, it’s been two days since my tooth extraction and bone graft placement and I also have stitches on the same place too. My concern is that I’m afraid my stitches might snap and something might go wrong. Also a lot of my bone is showing and I don’t know if something is wrong. The last thing is that even when I brush my teeth my breath smells bad from the recent extraction. Is that normal and what can I do to prevent the bad smell? I’m only 12 and I got the extraction and bone graft placed. And I’m really scared.

    1. Hi Stella,
      If you are only 12, you need to speak to your parents about this asap. You really cant have an implant until you are much older also.
      Dr. Amin

  40. Hello my name is Brandy and I really need your help. My husband got bone cancer in his jaw. There was a tumor they removed. Pet scan said cancer was not found any place else in the body. So they did a surgery removed bone, muscle and and a graft of skin from his leg and rebuilt his jaw with them. They placed bar and screws in there. They said that the cancer had started to travel to the brain but they were able to get it in time. Chemo and radiation for 7 weeks. 6 chemo and 30 radiation. We returned home Feb 24 the. Had a check up in June said it looked great and no cancer found. But a few days ago you can see the bone. A good amount of it showing. What can they do to fix it.

    1. not a lot of time for a long answer but to get back to you quickly……look into “hyperbaric oxygen treatment.”
      Best of luck and my prayers are with your husband

  41. Hello Dr. Amin,

    I had 3 bone grafts approximately 6 weeks ago. The other two have healed without complications. The one that is bothersome is the one I had done in the second molar position. My dentist put two membranes over the graft and stitched it up. He told me that at 4 weeks post-op he would take the top membrane out and stitch it back up. Afterwards I had agonizing pain in my jaw. I went back at week one and week two still in agony. My dentist informed me that some people just take longer healing. Mind you, the other two grafts have healed fine. At two weeks post-op I went on a weekend vacation out of state and during this trip, the top membrane started coming out ripping through the stitches. I was still only able to eat soups and smoothies. I was in agonizing pain but could not afford an out of state emergency room bill. The membrane worked its way out over the weekend. I called my dentist as soon as I got back into town. I was told over the phone that he could not see me until the following week. Needless to say, I have cancelled my follow ups with him and have not seen him since. Slowly over the last few weeks the pain has gotten better and the spot looked to be healing. I still have one membrane left in there. Well, the last couple of days I noticed a “bubble” forming in the space. It does not hurt but feels like it could pop at any time and has gradually gotten bigger. I have no signs of infection. No fever, redness, tenderness. Just a bubble that is now almost the size of the missing molar.
    Any information would be greatly appreciated!!

    1. Hmmm. All of this sounds a bit strange. You need to be seen by a dentist not an ER. The re-stitching thing is very strange. You likely had a dry socket on your lower molar under the graft. Not common but possible. The membranes need to be removed if they are the non dissolving type.

      Type in membrane in to the search bar on my blog for more info.

  42. Hi Doctor,

    It is nice to find this such an informative and interactive website.
    I have a question about my 25 years toothless gum. I am 37 years old now, and just realised my gum has been shrinking for ages and the appearance similar like on the 3rd picture (comparison between bone loss from extraction and socket bone prservation graft ) you provided above. The toohless gum is thin and shorter than the others.
    The question is, can the tooths next to it move to that toothless gum by using braces? I went to an Ortho Doctor and he said it can move. His advice was based on the X-ray I took on his place and his explanation was the bone was still there. But I still wonder due to that toothless gum is smaller than the tooths next to it.
    I hope I could get your opinion 😊.
    Thanks a lot Doctor Ramsey.

    1. It sounds like you’re trying to close a space. If it is in the back and very small and only a single space then perhaps it might be able to be closed in. Most of the time people are missing their molar tooth which is too big to really move and close a space.

  43. One month after tooth bone graft done I can feel small bone moving around. I’m terrified something goes wrong. Is it normal to feel bone moving & will it settle down again?

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

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

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

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

  46. Good afternoon,

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

    Please assist,

    Thank you ever so much!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      1. Hi again,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      Also try a night guard.

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

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

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

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

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

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

            With kindest regards,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      Very respectfully

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Please help

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

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

  84. 3 weeks ago I had bone graft , gum is healing well apart from one little tiny piece of bone which i can see ….
    failure of bone graft ??

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  98. URGENT – procedure in the morning

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

  99. Hello,

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

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

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

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

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

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

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

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

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

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

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

  105. Hello Dr. Ramsey,

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

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

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

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

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

      sorry ;-(

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

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

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

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

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

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

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

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

      Article 1

      Article 2

      Very Respectfully,

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

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

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

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

          1. Like ? I had a big bone piece come out the other night inch or two want me to email you the pictures I toke or contact me at itsnico101@gmail.com and ill inform you more I going thur alot of pain right now

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

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

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

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

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

  116. Hi Dr,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  125. Hello doctor,

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

    Thank you in advance

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

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

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

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

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

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

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

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

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

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

    Thank you.


  131. Hello Dr.,

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

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

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

    Thank you for your response.

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

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

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

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

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

  133. Hello Sir,

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

    Thank you,

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

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

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

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

    1. Merry Christmas

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

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

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

      Good luck and let me know how things are going.

      Ramsey Amin DDS

      1. Dear Dr…. Sir…

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

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

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

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

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

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

      Ramsey Amin DDS

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

    1. Very unlikely.

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

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

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

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

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

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

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

      Ramsey Amin DDS

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

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

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

  142. Hello Doctor,

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

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

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


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

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

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

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

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

      Happy Thanksgiving

      Very respectfully,

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

  143. Hello:

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

    1. Hello Christian

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

      happy Thanksgiving and thank you for your question.

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

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

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

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

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

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

      Ramsey Amin DDS

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

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

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

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

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

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

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

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

      Very respectfully,

      Dr. Amin.

  149. Hi there,

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


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

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

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

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

        Thank you for the quick response

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

          Each graft is very unique.

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

  150. Hello Dr. Amin,

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

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

    Thank you

    1. Andrew,

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

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

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

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

      Good luck

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

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

    1. Hello Ralph

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

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

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

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

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

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

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

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

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

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

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

      Keep us posted.

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

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


      Ramsey Amin DDS

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

    1. Hello Megan,

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


      Ramsey Amin DDS

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

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

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

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

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

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

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

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

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

      Very Respectfully,

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

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

    1. Hi Rob,

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

      basics of membranes and exposures

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

      Very respectfully,

      Ramsey Amin DDS

  161. Hi there,

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

    1. Hello Tiffani,

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

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

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

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

      Very Respectfully,

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

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

    1. Linda,

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

      Ramsey Amin DDS

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

    1. Hello Debra,

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

      wear to the bone come from?
      virtual surgery

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

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

    1. Hi Dee,

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

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

      Growth factors information

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

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

    1. Hi Annie,

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

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

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

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

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


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

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

    1. Hello PR,

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

      Wisdom Teeth Extractions

      Very respectfully,

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

  168. Hello,

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

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

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

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

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

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

          Good luck,

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

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

    1. Hello Rebecca,

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

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

      Dental Implant Bone Graft healing -What to Expect

      Very respectfully,

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

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

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

    1. Thank you Dr. Josh!

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

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Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.