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

Bone grafts video by Dr. Ramsey Amin DDS

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


 

 Factors

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

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

Feel free to ask questions below!

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


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750 thoughts on “Bone Grafts…How Long Do They Take to Heal? Dentist in Burbank Video

  1. charlotte ratcliff

    I am 45. I had a resistant infection in #19 for a year. I finally was able to have it pulled, and needed a bone graft. Its been 48 hours. The dentist did not give me any antibiotics afterwards. I feel like i have the flu now, and my face is swollen. It was the most painful dental procedure I have ever had done. Is this normal? Could the infection go to my brain? I informed my dentist that I am on meds for high blood pressure and I have angina/hypertension. Am I needlessly worrying? Are the ongoing heart palpitations normal?

    Reply
    1. RamseyAminDDS Post author

      None of this sounds normal. This in my office is a relatively painless procedure. The heart palpitations or likely not related and you may want to consider seeking emergency care. In my opinion the fact that you had a bone graft typically requires antibiotic coverage unless it was very tiny. Please follow tthis post to read more about antibiotics and I would suggest you start on one ASAP

      Reply
    2. RamseyAminDDS Post author

      None of this sounds normal. This in my office is a relatively painless procedure. The heart palpitations or likely not related and you may want to consider seeking emergency care. In my opinion the fact that you had a bone graft typically requires antibiotic coverage unless it was very tiny. Please follow tthis post to read more about antibiotics and I would suggest you start on one ASAP.

      Reply
  2. Mary

    I had a sinus lift, two week ago . I continue to have some sort of drip and a terrible taste in my mouth. Will this go away ?

    Reply
  3. Dipti Bhide

    Dear Dr. Amin,

    Firstly, thanks for answering questions and being generous of your time. I have the exact same issue as Ginger has stated below.I have reposted this as I am unsure whether an earlier reply of mine went through.

    In March 2016, I have had the last two teeth on the lower left jaw side extracted and bone grafts placed. The second last one had a failed root canal with an infection while the last one was extracted about a week later as it was going the root canal way and I wanted to avoid that toxicity. I’ve had a cap placed on the tooth just before the two extractions ( I think that’s tooth 20) and the area has been opened up and worked on several times after the initial extraction procedure. This was due to bone shards floating up to the surface,and a change in the fit of the cap on tooth 20. The holistic dentist I see had assured complete recovery of the area by maximum 5 to 7 months. I am still experiencing intermittent pain of varying intensity in the area! 3D X-rays show normal growth of bone and gum tissue too.

    Initially and midway through then and now, I have taken strong antibiotic to rule out infections. My annual physicals and bloodwork returned completely normal results. Initialy after the surgery, the pain was unbearable and I had to take prescription painkillers in order to function normally. Gradually, I switched to Ibuprufen, but after about two months of that I realized I didn’t want to risk upsetting my overall health due to it’s side effects.I decided to try an extremely high dose of Curcumin for pain control which works, but not as well. The effectiveness of Curcumin reached a plateau about 3 months ago and the pain still continues to go up and down in intensity at it’s own will. Initially, I had extreme sensitivity issues on the side of the extraction , which improved over time. However, I am still unable to chew on my left side as implants are unthinkable at this stage and I do not wish to undergo any more pain by using dentures.

    I have tried consulting an orthodontist who didn’t see anything wrong with my X-rays. He did see a tiny solid dot in the X-ray but stated that it seemed harmless as there was no apparent inflammation around it. Also, he felt surgically reopening the area and fishing around would cause more pain than help. He then referred me to a neurologist. The neurologist diagnosed me with Trigeminal Neuralgia and prescribed Gabapentin. This did not help the pain at all. A second Neurologist’s opinion was that this wasn’t a neurological cause of pain, it was post surgery trauma . He prescribed a stronger pain killer but could not pin point the physical cause. I am now seeing an Accupunturist to help with pain control, but it helps only occasionally. I am also working on breathing techniques to improve my mental health. Overall, I’ve lost about 12 pounds since surgery ( which could still be okay as I was slightly overweight earlier), but my chief concern is being fatigued all the time. My family and I have been through a lot of stress trying to figure out the physical reasons or problems that could be causing this prolonged pain.

    Can you recommend any specific imaging technique that can be done to to be able to correctly diagnose what’s happening under the gum line? Can you suggest any particular line of treatment? Thanks in advance,

    Dipti.

    Reply
    1. RamseyAminDDS Post author

      WOW… This is quite an unusual story although I have been consulted on this before. If it were me, I would surgically open the area and explore. There are times that the bone looks very normal on all x-rays including CBCT scans only to find loose bone particles, a foreign body or something inside the has not healed. This can stem into a condition called osteomyelitis or osteonecrosis. If you don’t have any sort of past medical treatment with medications of the bisphosphonate family, then this may be a very minimally invasive technique to at least look inside. Of course there is a chance it may flare it up and make it worse but there is no way to know this in advance.

      Reply
  4. Cristina

    I had a tooth with resorption removed 1.5 years ago. Bone graft was place and failed at the time. Tooth was ankylosed. Infection remained as well as 3-4 sinus tracts in the gum. Two other procedures to remove tooth fragments and replace bone graft were done along with a flap procedure. It has now been 7 months since the flap procedure. A large piece of bone made its way out yesterday. There is also still 3-4 sinus tracts remaining in the area. They cannot be tracked. Doctors have no idea what’s going on.

    Reply
  5. Esra

    Hi Dr. Amin so nice that you take time out of your busy day to answer concerns here. I had a tooth extraction #13 almost 3 weeks ago now and had a bone graft placed immediately after. The tooth was a failed root canal and had an abcess. After about a week it seemed to heal nice. I had the stitches removed 2 weeks after the graft and the membrane will be removed next week but my severe pain never stop. I got second opinion and took X-ray there is no infection healing nicely. It so much deep root pain I am having. I take pain killers but still I can feel troubling pain. Dr gave it to me steroid doze pack its my last day I can tell didn’t help for pain either. I lost my all hope being pain free and I really don’t know who else to go. Thanks again.

    Reply
    1. RamseyAminDDS Post author

      rarely is this a better option …..less invasive procedures may yield and inferior results. I do tunneling procedures for small grafts but generally not huge ones.. Protein is not a type of grafting material

      Reply
    2. RamseyAminDDS Post author

      rarely is this a better option …..less invasive procedures may yield and inferior results. I do tunneling procedures for small grafts but generally not huge ones.. Protein is not a type of grafting material,

      Reply
  6. Julie Chapman

    Aloha Dr. Ramsey, my name is Julie. I am 40 years old and had to have my front tooth, #18, removed and a bone graft was done. I had 3 root canals in that tooth since I was 17 years old. The dentist used L-PRF platelet theorpy for both the particulate bone graft and to make a blood clot to help heal faster. He then placed a Teflon membrane over the graft and the blood clot over that. He stitched it up at the extraction site and the upper gum as it had been cut open to help place the large membrane due to significant bone loss. We both were a bit supprised (me more so then him) at the significant bone loss. I lost the entire inside wall and the outter wall is quite thin. The cronic infections from the “ruptured tooth” had also started to eat at one of the sides as well. That tooth was “abnormally long” and I could feel the infections under my nose and now I can feel the graft there too. This brings me to my questions. I have been feeling a tightness at the extraction/graft site and have noticed the area getting dark. It seems to me the gums have pulled up a bit as it continues to heal. While I have no sign of infection, redness, pain, heat, pus, or a funny smell, I am a bit worried. I am sure that my concern is related to not realizing how bad things were until the the time of the procedure. I assume it is quite normal to feel the sight for a while, yet I worry now. I feel like I ask my dentist more questions then he has time to answer, as now I am hyper sensitive. While NOT a hypercondriac, I wonder when I SHOULD worry? The feeling around the sight is stiff (like after novacane wares off, only way I know how to explain it) when I smile or squint. While it is uncomfortable it is in no way actually “painful”. I do feel a bit of a pinch at times too, where the gum is still open and the Teflon membrane can be seen. Is this normal? And how long will it be uncomfortable? Will it go away as the bone solidifies? Could this be due to the Teflon membrane? I went in 2 weeks after the procedure to have the stitches removed and he was happy with how “EXTREMELY WELL” it was healing. That made me happy. I go in in 4 days to have the Teflon removed. Sir, I am sure you are a VERY BUSY man, and I am TRULY GRATEFUL for your informative website and your videos. They have been very useful in the last 3.5 weeks. And I thank you for everything you do for all of us wayward dental patients in need of information. Sincerely, Julie Chapman

    Reply
      1. Julie Chapman

        Thank you so very much. I did read the article and it answered more questions. Thank you! Im glad to see it is normal and will get better!:)

        Reply
  7. Donna L

    Hi , I had bone taken from the chin put into the upper front two teeth and six weeks later screws are showing and gum line is coming up I’m scared of failure this is my second bone graft in the same area within four months , in April 2017 I had bone graft on with cow and cadaver bone which failed not sure where I stand right now. The bone is still in place the fact that it’s open I am on anabiotic’s and it is only six weeks is scary . The flipper is not touching the gum he cut the Fake teeth down and did all that correctly from everything I’ve read , is it dangerous that the screws are showing and the block is open a bit ??? Donna

    Reply
    1. RamseyAminDDS Post author

      Ugh….this could be due to a number of reasons from technical ability, proper procedure choice, postoperative care and following of instructions, medical underlying disease. What you are describing his a block graft. I have done 100s of these and they are very successful. Are you certain that you are case has a good prognosis for bone grafting and implants? Although implants are typically the best option there are times where it is not the best for a particular tooth.

      Reply
  8. Mehri

    Hello Dr.,

    I’ve had 5 upper jaw teeth extracted ten years ago and I’ve been wearing partial ever since, now due to the damage the partial is putting on my other teeth I have to go for implants and bone grafts-sinus lift before that.
    My question is do you think the ten years delay makes it too late for bone graft?
    I’ll appreciate your advise

    Reply
  9. Mehri Tahouri

    Hello Dr.,

    I’ve had 5 upper jaw teeth extracted ten years ago and I’ve been wearing partial ever since, now due to the damage the partial is putting on my other teeth I have to go for implants and bone grafts-sinus lift before that.
    My question is do you think the ten years delay makes it too late for bone graft?
    I’ll appreciate your advise

    Reply
    1. RamseyAminDDS Post author

      10 years is definitely not too late. I have replaced teeth that did not have any teeth for 30 years! Sinus lift bone grafts are excellent but keep in mind another option for some patients is the zygomatic dental implant concept. Both are used to restore the upper back teeth. I would suggest you read up on both options and then find a skilled dentist to help you make final decision

      Reply
  10. Angela

    Hi Dr.,

    I have an underbite, a class III. After being in braces for 5 1/2 months my orthodontist suggested I have a bone graft and gum flap surgery, which I did. I think this was to build a stronger foundation and to allow my jaw to be stronger and to move the teeth quickly to mold the bone around the jaw. I am not sure if I am going to get a trans palatial appliance in the near months. I am wondering, since the bone graft was used with synthetic material and the gum flap from donor tissue, since I am 46 years old, what are the chances of something like this succeeding? Again I am still in braces and have another almost year to go. I am two weeks into healing and still eating soft food. The surgery is not common and still I don’t know the exact reasoning but I guess it is to build up the walls of my upper jaw.

    Reply
    1. RamseyAminDDS Post author

      This surgery does work well and is not common. By doing this surgery and graft it wakes up the bone and often allows teeth moving to go faster than normal.

      Reply
  11. Patricia Ercolano

    its one week post op my tooth number 30 removed the tooth above hurting and having spasms numbness on clindamycin tid im miserable in morning horrible jaw pain

    Reply
    1. Patricia Ercolano

      its one week post op my tooth number 30 removed the tooth above hurting and having spasms numbness on clindamycin tid im miserable in morning horrible jaw pain day 8,i have srjorgens and i have bladder cancer wondering if any of this could cause poor healing im a nurse and dont have time for this much pain im miserable

      Reply
      1. RamseyAminDDS Post author

        I have found by experience that patients with any type of cancer heal slowly and/or with more pain. I typically delay treatment for a long time if possible. A steroid given IV at the time of extraction would likely have helped a lot. I hope you are better now.

        Reply
  12. Anouar Hadj Taieb

    Thank you Dr. Ramsey for the insight!
    I did a bone and gum graft on my upper front tooth at the end of May, the plan was at the beginning to wait for 6 months to do the implant surgery but my periodontist said my bone is healing fast so we can do it earlier (at 4 months). Since my insurance is maxed out this year, I prefer to postpone the surgery to early January (7-8 months), so I would like to get your opinion if it’s recommended or not to keep the bone healing more than it’s necessary and is there any side effect?

    Best regards,
    Anouar

    Reply
  13. Andy

    Thanks again for you insight.
    I had (2) implants placed in the right side molar (top and bottom) in January 2017 and the DDS says they are ready for the crown.
    How long can I reasonably wait to put the crown in place. for insurance reasons I was going to wait until 2018. is there any issue with doing this?

    Reply
  14. Ginger

    Hello Doctor Amin,
    I had a lower left jaw bone graft (extraction of #18 & #19) last September 16, 2016. I am 50 year old female, in good health, no diabetes or autoimmune disorders that would cause me to be slow healing. I do have sinus and allergy issues at times. Every few weeks to months, I still have swelling flare-ups in the graft area of my jaw. I still have soreness if I use my jaw too much, if I do a lot of yelling (like at a ball game), and if I sing. I am currently having another flare-up and the discomfort is all the way up to my ear. I contacted my oral surgeon in the first few months of having the flare-up issues and she always says that everything looks good. It may look good, but it doesn’t feel good. I have been taking ibuprofen, turmeric, and tonight I am icing it again! My questions are: 1) have you ever heard of prolonged healing like this? 2) should I be concerned about infection? 3) if so, how would I be able to tell if there is infection in the bone? 4) what steps should I take next to get this issue addressed? At this point, there’s no way I would ever attempt to have implants to the site as I am terrified I would be dealing with these problems for the rest of my life. Thank you for your time!

    Reply
    1. Ginger

      Just to add, this was a cadaver bone graft. Also, I have regular yearly physicals and blood work done and there have been no underlying issues identified with my overall health. Thanks again!

      Reply
    2. RamseyAminDDS Post author

      Very very odd. Very odd. This may sound odd but I would see an endodontist and have them electronically test tooth 20…the one in front of the area.

      I would also surgically re-open the site as you may likely have loose graft particles or encapsulated material that can’t easily be seen on scan.

      You should not have to live like this!

      Hope this helps.

      Reply
      1. Dipti

        Dear Dr. Amin,
        Firstly, thanks for answering questions and being generous of your time. I have the exact same issue as Ginger below. In March 2016, I have had the last two teeth on the lower left jaw side extracted and bone grafts placed. The second last one had a failed root canal with an infection while the last one was extracted about a week later as it was going the root canal way and I wanted to avoid that toxicity. I’ve had a cap placed on the tooth just before the two extractions ( I think that’s tooth 20) and the area has been opened up and worked on several times after the initial extraction procedure. This was due to bone shards floating up to the surface,and a change in the fit of the cap on tooth 20. The holistic dentist I see had assured complete recovery of the area by maximum 5 to 7 months. I am still experiencing intermittent pain of varying intensity in the area! 3D X-rays show normal growth of bone and gum tissue too.

        Initially and midway through then and now, I have taken strong antibiotic to rule out infections. My annual physicals and bloodwork returned completely normal results. Initialy after the surgery, the pain was unbearable and I had to take prescription painkillers in order to function normally. Gradually, I switched to Ibuprufen, but after about two months of that I realized I didn’t want to risk upsetting my overall health due to it’s side effects.I decided to try an extremely high dose of Curcumin for pain control which works, but not as well. The effectiveness of Curcumin reached a plateau about 3 months ago and the pain still continues to go up and down in intensity at it’s own will. Initially, I had extreme sensitivity issues on the side of the extraction , which improved over time. However, I am still unable to chew on my left side as implants are unthinkable at this stage and I do not wish to undergo any more pain by using dentures.

        I have tried consulting an orthodontist who didn’t see anything wrong with my X-rays. He did see a tiny solid dot in the X-ray but stated that it seemed harmless as there was no apparent inflammation around it. Also, he felt surgically reopening the area and fishing around would cause more pain than help. He then referred me to a neurologist. The neurologist diagnosed me with Trigeminla Neuralgia and prescribed Gabapentin. This did not help the pain at all. I am now seeing an Accupunturist to help with pain control, but it helps only occasionally. Overall, I’ve lost about 12 pounds since surgery ( which could still be ok as I was slightly overweight earlier), but my chief concern is being fatigued all the time. My family and I have been through a lot of stress trying to figure out the physical reasons or problems that could be causing this prolonged pain.

        Can you recommend any specific imaging technique that can be done to to be able to correctly diagnose what’s happening under the gum line? Can you suggest any particular line of treatment? Thanks in advance,
        Dipti.

        Reply
  15. Karam Al-Hassanieh

    Hello Doctor Amin,
    I had my 4 wisdom teeth extracted and a bone graft procedure done last Tuesday. Oral dentist took some bone from my lower jaw and placed it on my upper jaw. (I have two frontal teeth missing) My only concern is that my partial puts lots of pressure on my bone graft. How fragile is the area at this stage, 5 days after the surgery?

    Reply
    1. RamseyAminDDS Post author

      Yikes. This is the worst thing possible for the partial to put pressure on the graft!! Take it out and see your dentist asap before you have opening of the wound which will lead to graft failure or poor results.

      Reply
  16. Karen Chandler

    I had two implants and a sinus lift, upper right side, 5 days ago. The swelling is so post gone and my discomfort is minimal. What is still bothering me is that I feel like the roof of my mouth is swollen. It feels a lot like when you burn the area eating or drinking something too hot. Is this within the realm of normal?

    Reply
  17. Melissa

    Hi. I had a previously root canaled tooth extracted and a bone graft on a lower left tooth 13 days ago. I see bone in the middle of the extraction site. Should I be concerned? Will the gums eventually close over the bone? Thank you!

    Reply
  18. Anna

    Hi Dr Amin,
    I had all of my wisdom teeth removed last Wednesday and 1 was badly impacted. I had to have a bone graft at the time next to the impacted tooth. It is now Saturday and I still have pain in my jaw and my face/cheek is still swollen both on the impacted side. It hurts to open my mouth too wide and can only eat soft foods that I can basically drink or not chew. I have a few questions: do you think I have a dry socket? Do you think it is ok for me to travel on a plane next Friday? And finally, how long do you think it will take to heal? Thank you

    Reply
    1. RamseyAminDDS Post author

      It is not to the bone graft that is causing the pain. It is the wisdom tooth extraction that is causing the pain. Some wisdom teeth are really terrible and to have prolonged healing. Hopefully received IV sedation along with an administered intravenous steroid and an additional intramuscular steroid at the time of extraction. This will help you heal much faster. I also use L PRF made from your own blood into most all extraction sockets. It helps with pain and also helps with dental implant bone graft healing. I use it daily. Hang in there, it might take 1-2 weeks for things to all get normal again. You should be able to fly but I would see dentist before you leave.

      Reply
  19. Ryan

    After having a tooth extracted (old root canal originally) I had a bone graft done as well. the graft was done with bone that was mixed with antibiotic to form paste and injected into the extraction site, this was done on a bottom molar. My question is, do my gums have to completely close over fully in order to have my implant placed? I still have a “hole” where my gums haven’t met yet and am a little over a month post graft.

    Reply
    1. RamseyAminDDS Post author

      The hole should diminish over time. At 1 month out, it is not unusual to have a depression in the area where the tooth was removed. Hopefully in 4-6 months, when the implant is ready to be placed, the gum has flattened. Sometimes a membrane is used to control the shape of the gum and bone formation.

      Reply
  20. Linda Rebstock

    Dr Amin,

    I broke the cap off my implant on labor day of2014. I went back to the surgeon who did the implant. He had to pull it out. He bone grafting me and had to heal for 8months. After that he placed another implant. That healed for another4 months. When he put the cap on he pushed it so hard that it compromised the bone and my sinus drained my throat for over a year. No one could help me. The dentist who did it didn’t want to see me anymore! I went to an ENT doctor and he placed bone grafting. Now I have bone grafting and mucus leaking out. I have a bridge over the area and its really been a nightmare. Can I talk to u?

    Reply
  21. VL

    I had a bone graft on my lower left number 19 space. I had it on a Tuesday today is Saturday and it is still aching. I feel like I have mumps on my left cheek. Will this improve soon? I continue to take ibuprofen and Tylenol. Diligent in the mouthwash and antibiotics.

    Reply
    1. RamseyAminDDS Post author

      it should heal, the pain is likely from the extraction and not from the graft. It was likely a difficult tooth to remove

      Reply
  22. Laurel

    I had a bone graft on the 11th. I have intense pressure in my gum area where the graft was placed. Its so much pressure it hurts! Is this normal. I am on constant ibp but it’s not helping much. I just want to know if the pressure/pain is normal.

    Reply
  23. Vickie

    I have bone grafts on both lower sides of my jaw. I had this done in January and I now feel the screws that hold the block grafts. Prior to putting in the screws for the implant does the oral surgeon remove the other screws?

    Reply
  24. Liz

    Hi, I was hoping for some advice. I had an implant post and bone graft placed just over 3 days ago (dentist said my bone was hard and the implant was solid, but as there was a thin ridge, he placed a bone graft to help with implant success). Area was stiched closed. The first 24-48 hours were okay and pain was completely controlled by simple meds. However after 48 hours my face was swollen and bruised around the site of implant and the pain increased significantly. The swelling has now gone (almost completely) but the pain is still awful (throbbing, like dry socket or an awful infection), dentist has checked area and said healing well and no visible infection and pain likely due to graft healing, have been on antibotics for last 24 hours just incase. However, Ibruprofen and paracetamol are not even taking the edge off the pain and I cannot rest. Is this level of pain to be expected going into Day 4? Many thanks.

    Reply
    1. RamseyAminDDS Post author

      If your bone was truly very dense, that could lead to prolonged pain that is not usual. Most bone is medium density D2/D3 well you may have had the highest density D1 bone.
      You would think that bone that is really solid is better but when he gets too solid it lacks some blood supply and leads to prolong the healing and sometimes failure. I would suggest a steroid be given to you at the time the implant is put in or add some on now if possible.

      Reply
  25. Alexis Swiniarski

    I got an extraction and bone graft done on the right side 5 days ago. The area is still very swollen and hard to the touch on the outside of my face. Is this normal?

    One last thing, I developed Bell’s palsy (full paralysis) on the opposite side two days after the procedure. Could these be related? I’m getting mixed information online. I had Bell’s palsy 7 years ago. Followed up with doctors who believes the surgery stunned the nerves and caused it but dentist said there is no cross over with facial nerves so it wouldn’t be from dental procedure. The dentist did tell me the tooth was infected but did not put me on antibiotics until after the procedure. Could this be another factor?

    Reply
    1. RamseyAminDDS Post author

      The Bell’s palsy on the opposite side is not caused by your dental work but it can trigger it. This may be due to a hidden virus. It will likely go away. Some steroids often help.

      Reply
  26. Pamela Robins

    Hi, I had my tooth extracted and a bone graft done 4 weeks ago. I developed a very bitter taste in my mouth a couple days after the surgery and thought it was from the antibiotics. 4 weeks later I still have the constant bitter taste. Went to oral surgeon the other day for post surgery checkup. He said the area is closed and healing beautifully and that the bitter taste was not from the tooth and that it must be from some other unrelated cause! It seems too coincidental to me! Do you think it could be from the bone graft? Or what else could it be? Should I be concerned? Thanks!

    Reply
    1. RamseyAminDDS Post author

      My guess is that it is not completely healed yet. In 4 weeks the socket is probably still slightly open if this was a socket preservation bone graft. If you do not have pain, just give it a bit more time and it should hopefully go away. This is not common but does fall within the range of normal.

      Reply
    2. RamseyAminDDS Post author

      My guess is that it is not completely healed yet. In 4 weeks the socket is probably still slightly open if this was a socket preservation bone graft. If you do not have pain, just give it a bit more time and it should hopefully go away. This is not common but does fall within the range of normal.,

      Reply
  27. Eileen

    Is there any problem to wait to have implants started after tooth removal and bone grafts. I’m about one year past but want to wait a while more for starting implants. Is this okay?

    Reply
    1. RamseyAminDDS Post author

      It really depends. The bone grafts will begin to shrink also especially depending on what type of bone composition was used. If I have a patient that I know will take longer to complete treatment, my grafting composition is completely different than someone who needs to finish ASAP.

      Reply
  28. Jen

    Hi I had a tooth extraction with a bone graft 4 weeks ago and now today i feel pain and have had bleeding at the wound area. It seemed like it was healing fine but now there is blood. Is this something I should worry about? I have my second post op appointment in two days. I think ai have been clenching my teeth in my sleep so I now feel pain all throughout my mouth and now the bleeding.

    Reply
  29. PAT

    Hi – have just had a double sinus lift which is healing well. However on removing the stitches it became apparent that my lip had been stitched to my GUM. Ouch to that. It’s now REALLY sore. Plus I have had much more bone graft on one side and now have a lump. I’be been told this excess can be removed when I have the implants fitted. But my question is – is this a normal practice? Many thanks

    Reply
    1. RamseyAminDDS Post author

      That is a good thing to have extra bone on the outer wall of the implants. Unless it is really excessive, I would not cut away. The cheek is sometimes “borrowed” to cover the bone graft during healing duration. When the implants are placed and or uncovered, the cheek can be put back with a vestibuloplasty. This can be done with a laser to easily restore the cheek back to normal. I do is all the time with a carbon dioxide laser.

      Reply
  30. Susan

    Dear Dr. Amin,

    Is it possible for a bone graft to become infected three months after it was placed? My first upper left molar was extracted, after an X-ray showed that the root canal in that tooth had failed. A bone graft was placed at the time of extraction. I was not given antibiotics when the bone graft was placed even though an abscess was removed that had not been seen on the X-ray. The doctor said he would prescribe antibiotics only if I developed an infection at the site. After a week, I used a Peridex rinse for a couple of weeks. The site was checked again, which would have been about three weeks after the bone graft was placed. The doctor said the site showed no sign of infection even though I had experienced pain there. The pain subsided. He said not to return for a few months, at which time he would insert the titanium rod.

    Coincidentally, I had to have antibiotics for a root canal done on a different tooth soon after I finished the Peridex rinse for the extracted tooth and bone graft; in fact, I had two rounds of antibiotics for the root canal. I have now been off antibiotics for 4 weeks, the longest period that the bone graft site has not been exposed to either antibiotics or Peridex.

    Is it possible that an infection was brewing in the bone graft site but was kept at bay by the antibiotics prescribed a few weeks later for the root canal? I cannot even wear the flipper because it hurts now; it had been comfortable until just recently.

    If the bone graft is now infected, how can it be diagnosed? Is a X-ray sufficient to diagnose a bone graft infection/failure?

    Thanks for any help you can provide.
    Susan

    Reply
    1. RamseyAminDDS Post author

      YES –Is it possible that an infection was brewing in the bone graft site but was kept at bay by the antibiotics prescribed a few weeks later for the root canal?

      Sounds like things aren’t going well. So sorry. Antibiotics are not always necessary but typically for bone grafts were a very good idea. Please listen to the video on antibiotics to learn a little bit about it. Have a new 3-D scan taken for regular x-rays to evaluate the bone. You may not know until you actually reopen the area if it is questionable.

      Reply
  31. Tim

    Hello i had a bone graft done on my bottom front area. 4 missing teeth in that area one was pulled. Their is also a root canal on the k9 in that area. My surgeon told me it’s an 8 week healing time and he’s going to place the implants soon. He said he can replace some of the bone that has come out (basically a chunk of it), when he’s placing the implants. Is this going to work out?

    Reply
    1. RamseyAminDDS Post author

      8 weeks is not enough time for a bone graft to heal!!! It takes time for your body to convert the graft into your own if it is cadaver bone. Better to wait 4-6 months then to try to go in early into soft bone!

      Reply
      1. RamseyAminDDS Post author

        Without seeing you that is impossible to tell. Sorry. You should discuss this with your dds.

        Reply
  32. Scot

    Dr. Amin – Due to a broken bridge I am looking at a couple of implants to repair. I am trying to decide between two oral suergeons that have basically put forth the same treatment plan. The only real difference is that Dr A proposes using my own bone marrow from my tibia for the graft while Dr B proposes bone grafting material from a cadaver. I was hoping you may have some insight if one approach better than the other from a perspective of success rate along with if one approaches heals quicker than the other?

    I will say that the insights on this site are enlightening. Thank you for the time and feedback.

    Scot

    Reply
    1. RamseyAminDDS Post author

      I can’t send you a link right now but watch the video on block grafts a 2015 update. I describe this very thing!!

      Reply
  33. Monica

    Hello! I just had front teeth implants put in, now I’m waiting for bone graft. but my dentist didn’t give me anything to cover the area, I was told it will take up to 4 months to see the results , but I can’t be that long without teeth.
    What can I do?

    Reply
    1. RamseyAminDDS Post author

      That’s nuts!!! No temp!!
      You can have a quick flipper made in 2 days thy looks good and gives you your dignity back.
      I never let my patients go without teeth!

      Reply
  34. Lauren

    I had an upper tooth extracted with synthetic bone grafting 9 days ago, the first few days I was fine and then I developed large ulcers where the sutures entrance and exit sites were, I developed continuous dull pain and tenderness, I have been living on Motrin to help with the discomfort. My sutures became loose and were super tender. I finally caved in and called my dentist back- they removed the teflon Pth suture and felt I may be allergic to the suture. They placed me on amoxicillin and chlorhexadine mouth wash.
    Two days later I’m still uncomfortable and utilizing 600mg of Motrin Q6 hours, the pain feels as if it’s in my upper cheek bone now and lower jaw when I bite. The site is not red or inflamed besides the ulcerated areas ( inner roof of my mouth and the outside gum tissue surrounding the graft site.) Please let me know what you think? Is this pain normal and why theses horrible ulcers?

    Reply
    1. RamseyAminDDS Post author

      Sometimes Dentistry can trigger alters the form in the mail specially if you had them before even just one or two.

      Typically, antibiotics are are used at the front end of an extraction/bone graft.

      I doubt you are allergic to any sutures at all. Too rare.

      Also, are you sure it was synthetic? That is typically the worst type of bone to use especially if you are planning on having an implant.

      I hope you are better now. 🙂

      Reply
      1. Lauren

        I’m certain it’s was synthetic- ugh why is that the worst to use? I wasn’t given an option and had no prior knowledge to any of this. I read somewhere that the suture could have been tied to tight causing the ulceration. I am so much better now but definitely concerned regarding the type of graft-

        Reply
        1. RamseyAminDDS Post author

          Synthetic doesn’t actually make bone. It just holds a space like a filler. It is not alive so the process of integrating an implant is not as good into bone that is not truly alive.

          Reply
    2. RamseyAminDDS Post author

      In my practice this is usually a near painless recovery with and extremely slight risk of complications which are all reversible.

      Reply
  35. Hardeep kondal

    Hi
    I am hardeep. I had a cyst removal surgery of my front two teethand filled with bone graft on 29th of october and its been 4 months now. But still i am feeling some kind of stiffness and pressure in my gums. My doctor is saying that it healed totally . Can u please tell me why this kind of stiffness is still there.

    Reply
    1. RamseyAminDDS Post author

      Take a scan. Do not place any dental implants in the area until you are pain-free. Something seems wrong of course.

      Reply
  36. John paul

    Tooth#4 was surgical extracted and a bone graft was done and sutured. A week later the suture came out and the two tissues separated from each other now the flap of the gums are not shape on tooth #3 and #5.i could pull the flab up a little. Now there is scar tissue and that’s why is not attached now.
    What do I do?do I go to pero to get the gums recut and sutured and reshape??? I had and oral surg that did the extraction.

    Reply
  37. John

    Tooth#4 was surgical extracted and a bone graft was done and sutured. A week later the suture came out and the two tissues separated from each other now the flap of the gums are not shape on tooth #3 and #5.i could pull the flab up a little. Now there is scar tissue and that’s why is not attached now.
    What do I do?do I go to pero to get the gums recut and sutured and reshape??? I had and oral surg that did the extraction.

    Reply
    1. RamseyAminDDS Post author

      The area will reshape itself over time. The body contours things back to normal. Just give it time.

      Reply
      1. John john

        how long does it take for the gums to reshape it self and the detach flap to attach to each other where it was cut .will it contour it self and look natural?

        Reply
          1. John john

            I said the gums will reshape within 6 months.does that mean the flab will be smooth and reshape against tooth #5 and 6 the flab is still detached any thing to worry about??

          2. John paul

            I went back to my oral surg and he said he was happy with the result. I’m not sure if he was me the truth. #4 was extraction the suture came out and the gum line on tooth #3 tissues detach because of scar tissue. I have a little Excess tissue at the gum line that is detach, will that tissue attache it self and make it contour around tooth #.its been in Feb that I had the extraction. does it take more time.i was told that scar tissue won’t attache itself is this is true?
            my surgeon said when he does the implant he can repair the Excess tissue. can you tell me how.
            please help me this really upset me.should I go to a perotpero to fix it?

          3. RamseyAminDDS Post author

            Sounds ok. The excess is easy to deal with. Always better to have more than less!!!

  38. Hajir

    Hello Dr. Amin – I am from Washington state and i stumbled upon your website after several google searches. I got a failed root canal extracted on February 11 (it had to be pulled out in fragments) and a bone graft done. It is February 24th today, I got my stitches taken out a week ago. My gums havent fully closed over the top. They have only closed over halfway. There is still a tiny opening in the center, and my dentist said I was healing fine and that it takes time for the gums to completely close over the collagen plug. Is this true? Should I be worried – It will be a full two weeks tomorrow. I have no pain or swelling. I just want my gums to close over already. Thank you for your help.

    Reply
  39. Krissy

    I just had 6 front crowned teeth ground down and a temporary bridge placed over it. One had a post that broke and the post was pulled and filled with something during the process. That spot and two others have to extractions done and filled with a bone graft in 2 weeks to then have the permanent bridge cemented in. I’m told the bridge will be supported by the 3 ground remaining ground teeth. This was all done as of one of the very front teeth receding at the gum and another tooth had become loose of the broken post. Right now the temp is very sloppy the whole back is too thick causing me to not speak properly and one of the canine teeth is too big being pushed out against my lip. There is also messy patches of acrylic up at the gum line. Is this the best plan going forward and what should I be asking my periodontist to do in 2 weeks to ensure this bridge lasts. Will I be able to leave the office with teeth after the bone grafting is done?

    Reply
    1. RamseyAminDDS Post author

      Typically if you are having bone grafting underneath a six tooth front bridge, you would stay in the temporary bridge for one to six months to allow the gum and bone to heal. The temporary should be very smooth and of course you should always be with teeth. I can’t speak for others, but when patients leave my office there temporaries are aesthetic, smooth and comfortable. Temporaries are very important for the formation of gum triangles around the bridge or dental implants.

      Reply
  40. Tom

    Dr amin
    I had a maxillary central incisor implant placed along with bone grafting about 6 months ago as apparently the outer wall needed some reconstruction. yesterday it was found that although encouragingly bone reconstruction had occurred on the outer wall but some more grafting was needed. So, a small about of graft material was added with resorablbe membrane to build up the rest of the outer wall . the implant was kept there untouched. I have a few questions
    1)is this standard procedure after a bone graft is partially accepted?
    2) how many months should this bone graft take to get accepted?
    3) is the implant that has already been placed 6 months ago likely to get Osseo integrated after the repeated surgery.

    Reply
    1. RamseyAminDDS Post author

      It is not uncommon for the most difficult tooth in the entire mouth (maxillary central incisors) to require additional secondary bone grafting. With these difficult teeth, you have to do what it takes to get a great result. The additional bone graft will likely take an additional 4 to 6 months to heal. I would advise going slow rather than fast and definitely transitioning through a temporary so that the gum triangles can fill in properly. It is all about a cosmetic final result that will be long-lasting.

      Reply
  41. Natalie

    Hi,
    My name is Natalie. I had an infection in a root canal crowned molar. My dentist pulled it for me and added bone graft without telling me. It ended up abcessed for 2 months. Took 3 different antibiotics and and IV antibiotic in the hospital to finall get rid of it. It has been about a year maybe longer and it still hurts up into my check bone. I have a permanent bruse there, also I have been having a cluster of itchy painful sores starting where the site is up to my ear on my face. The dentist said it is healing good and looks good. But it is still hurting a long with what may be arthritis feeling in my body. The site is still sore to touch. I am at a lost in what could be going on and what needs to be done. I have had nothing but infection tooth after infectiin tooth. Been to ER like 40 times and on antibiotic 38 times. Can you please advise me as to what can be going on and what needs to be done. Thank you!

    Reply
    1. RamseyAminDDS Post author

      What you are describing is extremely rare but can happen. You need to be looked at by an infectious disease doctor and by a hematologist. You could have a special issue that nobody knows about… Not even yourself. Some people are at risk for slow bone healing such as osteomyelitis due to unknown underlying medical conditions. I have seen this before! You need to be looked at for very rare deficiencies of enzymes and other things that allow normal healing to occur. I’m sorry you’ve gone through all of this but this is not normal at all. I have done many thousands of these procedures.

      Reply
  42. Laira Reid

    Hi!

    I read your article, but I don’t think I had a bone graft.
    My tooth was extracted, sutures and filled with some type of filler to prepare for a bridge. I am at 48 hours and I have pain and at the site. The problem I am having is that it feels like it was over filled. My tongue keeps going to the side of my mouth due to there being a ridge and a slight jagged spot that comes down my inner gumline made up of he material. It feels very low and is very sore around the edge if it and I think the slight jagged part may be scraping my tongue slightly. Is this normal or should I go back get away?

    Thank you!

    Reply
    1. RamseyAminDDS Post author

      that looks like a very poorly made temporary bridge made of acrylic or resin. It should be smooth and not jagged. That is not a bone graft

      Reply
  43. Andrew

    Hello. My mother (age 70) has pending treatment for upper and lower “all on 4”, which includes a lot of bone grafting and implants that same day. There may also be potential for up to 6 implant on each arch. I guess my main concern is that she has diabetes, which I am currently monitoring. So far, her levels have been ideal for this procedure (5-6% A1C). Would she be okay to proceed with this type of procedure, and if so, how long would it usually take for healing? She’ll be traveling internationally after 1.5 months post surgery… I just want to make sure we’re fully aware of what’s going to happen before and after, and that she’ll be fine while traveling abroad. Thx!

    Reply
  44. Steph

    I got a bone graft after getting a tooth pull. Need a couple filling right next to it. How long should i wait? Will the drilling affect healing process?

    Reply
  45. Elizabeth

    Help. I need advice. I had an extraction and bone graft on #14 10 days ago. First 2 days were fine. 4th day started with pain and I have been in extreme pain ever since. I have gone back to my dentist everyday for the last 6 days and had the area cleaned, and packed with dry socket (eugenal) packets. I get immediate relief until the packets fall out a couple of hours later. A CT scan was done by a different oral surgeon yesterday, which showed no sign of bone graft or membrane placed on top of graft. I was told that I could not get a dry socket after a bone graft, so I am puzzled. I have had dry sockets before, and this feels like a dry socket that just won’t heal. I went back to my original dentist today and he repacked the site and increased my pain meds from Narco to Percocet. I have been taking Clindamyacin for 10 days now as well. No welling or fever. Just extreme pain.
    Your thoughts or advice would be greatly appreciated.

    Reply
    1. RamseyAminDDS Post author

      Dry sockets do not occur on the upper jaw. I would remove the graft entirely and let it just heal on its own. Something is not right. You may want to consider using a steroid to help with jawbone inflammation along with the antibiotics.

      You can still have the implant later. It was a good thing that you had a CT 3-D scan done. Make absolutely certain that you do not have a flareup of a tooth right next door that is giving you the feeling that it is the extraction socket. Strange or things have happened!!
      Keep me posted

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

      Reply
    2. RamseyAminDDS Post author

      Dry sockets do not occur on the upper jaw. I would remove the graft entirely and let it just heal on its own. Something is not right. You may want to consider using a steroid to help with jawbone inflammation along with the antibiotics.

      You can still have the implant later. It was a good thing that you had a CT 3-D scan done. Make absolutely certain that you do not have a flareup of a tooth right next door that is giving you the feeling that it is the extraction socket. Strange or things have happened!!
      Keep me posted

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

      Reply
  46. James Henry

    I recently got a bonegraft for 4 missing upper front teeth that got knocked out in preparation for implants (about 2 weeks ago), my dentist told me not to move my lip over the bonegraft and not touch the back of my gum with my tongue as I could move the graft. About how long will it take for the graft to set before moving it won’t be a big issue and what are the chances that if I accidentally bumped it something would go wrong? I think I might have slept weirdly on it, but there is a mesh protecting it I think. Thanks!

    Reply
  47. Andy

    Thank you for sharing the knowledge.
    I recently had tooth 18 pulled and bone grafted. Seems to be going well.
    I have been missing tooth15 for 20 years and have never missed it.
    All my wisdom teeth have been extracted.

    My question is in light of 15 missing does it make sense to spend the $ on an implant?
    I have another tooth that needs repair so this is second in line anyway.

    Reply
    1. RamseyAminDDS Post author

      In the American numbering system 15 opposes 18 meaning they bite against each other. If you have a standard, class one bite unless you replace both of them you probably are fine without either of them.

      If you have an underbite or overbite the standard overlapping does not occur and you might need a tooth on one side but not on the other. Have the dentist evaluate your bite closely to see if either is necessary. As long as you have 19 and 14 molars you will be in good shape.

      The reason why I bring up the American numbering system as many people on this forum are from all over the world and tooth numbering systems are different internationally. I assume you’re in the United States

      Reply
  48. lucy

    Hello,
    please can you advise about my situation. I had two denal implants placed in september for my two lateral incisors. at the same time of surgery, i had guided bone regeneration.
    2 months after surgery i developed a small spot above the site of one of the implants and pieces of bone graft have been coming out ever since. they are like grains of sand in my mouth.
    i have been to see my surgeon about this and he advised he wasn’t worried and should heal naturally on its own however it has now been about 6 weeks since the particles started coming out and the little spot where the bone is escaping hasn’t healed. i would say that about 3 particles come out per day ish.
    last time i saw the surgeon he said that “there was something he could do ” if indeed it hadn’t healed by my next appointment but this is now two weeks away and i see no sign of it healing up.
    should i be worried? what can potentially be done about this? just an additional note – the spot isn’t swollen or painful – it just swelled and was painful when it first started and i was given antibiotics and it settled down.
    i would appreciate your input and time.
    thank you

    Reply
    1. RamseyAminDDS Post author

      Most of the time these heal up on their own without intervention. More surgery often causes recession and thins the tissue. I would not be in a race to do anything except removing small particles. Because this is the upper front area, going slow and being conservative is the way to go. The GBR procedure is very different than a block graft where bone exposure could be more of a problem.

      Reply
  49. Robert Harris

    Please help.

    I had an extraction, sinus lift, bone graft, and implant all done the same day. The dentist said I had a cracked root under a crown that was infected. I experienced severe pain for 7 days after the surgery. I was prescribed pain meds and 7 day amoxicillin antibiotic. I called my dentist twice in this seven day period to express my concern over the severity of the pain. I could not even go to work. He said it was normal. One day after finishing the antibiotics I immediately came down with severe flu like symptoms. I went to see my dentist and all he did was take a mirror and look at the extraction site and stitches and said everything is healing fine and I probably have a cold or flu. After 5 more days of running a mild fever and experiencing severe flu like symptoms I went to my family medicine doctor. She prescribed me a 5 day course of azithromycin. Within two days my flu like symptoms went away and the only thing that’s remaining is a tightness or pressure in the gums and nasal area where the bone graft and sinus lift was done. Stitches are still in but occasionally get small granules that come out. It’s been 15 days since the dental surgery was done and my dentist seems to think everything is healing like normal but has not done any follow up X-rays or CT scan. Is the pressure normal? Can the flu like symptoms be from an infection due to the surgery or failure of sinus lift, bone graft, or implant?

    Reply
    1. RamseyAminDDS Post author

      None of this is normal but ’tis the season for illness for sure. The pain could indeed be an infection that was underlying. Azithromycin isn’t a great antibiotic for dentalso it may not have been that. It is very possible that you had both the flu and a dental infection at the same time giving rise to the perfect storm and the timing of the second antibiotic could’ve just been the flu running it’s normal course. In 17 years of doing many thousands of implants and bone grafts I have seen this before.

      The pressure part is not normal. I would definitely do a repeat scan just to see how things are.

      Reply
  50. Joseph Laudadio

    Thank you for the amazing video! Today was one of the most emotionally draining days of my life, and I’m hoping you can shed some light. After a failed root canal and failed appendectomy, I had my front tooth extracted on September 21 (a few months ago) and had a bone graft done that day to prepare for an implant. Sadly, in November, I had to have two more bottom back teeth extracted and grafted as well. When I went back to have those bottom stitches out, the doctor said my front tooth looked wonderful (November 16 to be exact), and it was “ready” for the second step…the screw and abutment. The weeks that followed were an absolute nightmare. Pain radiated up into my eye socket, swelling, two rounds of antibiotics…until finally about a week ago, I started to feel better! I saw the doc and he said “I turned the corner” and it looked great! Well, I woke up this morning and noticed the screw was moving. I ended up in the chair about 3 hours ago, only to be told the implant had failed. After I cried hysterically (yes, 41 years old crying)…he proceeded (and the “he” was a different doctor…more thorough and nicer!) to take the screw out, numb me, clean out the infected tissue, and perform another bone graft. He said we will try again in a few months. I am NOT a smoker, no diabetes, etc. My question is a rather simple one…did we put this screw in way to soon? It was only 2 months! Now, something worth mentioning is that when he was placing the screw, he could not believe how strong the bone was! He actually bragged quite a bit about how well the graft took! I am thankful for my flipper but so concerned about what will happen next. I have a bottom pair of back teeth that I wanted to have done as well yet I am back to square one! Any thoughts would be welcome and comforting. My heart is broken and I’m absolutely lost Doctor. Thank you again for all your help….

    Reply
    1. RamseyAminDDS Post author

      did we put this screw in way to soon? YES…..for a front tooth I would delay this much longer as the bone structure is very thin in this area. Bone grafts heal differently than regular bone sockets. They require more time and trying to do things to early into a grafted site is too risky.

      In my practice I would do the implant and the bone graft simultaneously or they would be staged apart by 4-8 months. These techniques in my hands works extremely predictably every time.

      thank you for your kind words

      Reply
  51. Shaun Michaels

    Hello Dr. Amin, Thank you for providing us this wonderful website! I had a molar extracted two weeks ago and a particulate bone graft. I am still getting bone particles in my mouth throughout the day- not many, maybe 4-6 per day. My done graft is very much visible and I have a divot where the tooth was extracted. The site is not infected, but the hole is not getting smaller. Is this normal? I saw my dentist yesterday and he said people heal differently and not to worry. I am young and have always healed quickly. My question is, do you think- in your professional opinion that this is healing? I’m scared the gum tissue will never cover the hole. I wish I was still in LA, I would have come to you. Thank you- Kind Regards, Shaun

    Reply
  52. Amy

    My husband had all of his teeth removed in preparation for full top denture and implants on bottom denture. The extractions were done over a month ago. Cadaver grafts were done. He still has a lot of pain on his left side. In addition, there is a hard lump at the site one extraction that had bone added. His temporary bottom denture does not fit well because of this. Is the hard bone swelling normal at this stage? He still cannot eat comfortably.

    Reply
    1. RamseyAminDDS Post author

      Needs to get another soft reline ASAP. That should help. Have the lump looked at while you are there.

      Reply
  53. Nona

    Hello Dr Amin. I had all of my teeth extracted and got dentures in 2004 at the age of 39. My lower denture has never fit and I was told I was not a candidate for implants due to lack of bone. Grafting was never mentioned as an option until 2 years ago when my lower denture broke. I went in to get another one rather than have it fixed because the fit had gotten so bad. My dentist told me that not only did I need a bone graft to support implants, I needed it just to support a denture. My ridge in front is non existent and totally flat. In the back it’s very short and narrow. I have been so fearful of having to go without my denture after the graft, I haven’t been able to make myself even see a Dr for a consultation. Would I be able to wear my denture after the surgery? I really do want to do it because it would be great to be able to eat without pain and constant sores in my mouth.

    Reply
    1. RamseyAminDDS Post author

      It is extremely rare that I need to do a bone graft on somebody that has no lower teeth at all. A fixed dental implant bridge can be provided very easily even with basically “no bone.” You need to find a very skilled provider to do this.

      I have many examples on my website of people I have treated which have jaw bone the thickness of your pinky.

      Reply
  54. Mathguy

    A family member requires LARGE upper and LARGE lower jaw ridge augmentation. The surgeon proposed two alternatives. (1) Harvest bone from jaw area (in dental office) (2) Harvest bone from the hip (requires hospital stay). With option 1, (harvesting bone from hip), the surgeon can do the upper and the lower ridge augmentation at the same time. With option 2, (harvesting from the jaw area), he will do the upper first, wait one or two months, and then do the lower jaw.
    We are wondering how these options compare in terms of durability of the final implants. Doing both upper and lower jaw at the same time, does it slow down the healing time? Would the patient recover faster, if the upper and lower procedures were done at separate times? Would there be terrible suffering if both upper and lower done simultaneously? For the time being, lets ignore the cost difference. 🙂

    Reply
  55. Ashley

    Hello,

    I had an extraction and bone grafting done about 7 weeks ago. There are still grafting particles coming out of the gum. At my one month followup, they removed the pieces there.

    Is there any cause for concern that the particles are still coming out? Is that a sign that it’s being rejected?

    Reply
    1. RamseyAminDDS Post author

      Please type in “membrane” into the search bar and read that post. It will help you understand!!
      Can’t attach link from iPhone

      Reply
  56. Carol

    I had a tooth pulled and a bone graft in preparation for improvement implants. That was eleven days ago. I’m still in pain and just yesterday the roof of my mouth on the side of the mouth where the work was done has become swollen. Is that normal ?

    Reply
  57. Denise Dambra

    I just had a bone graft in preparation for an implant on the bottom right. I waited 5 months then got a 3D X-ray. The bone graft took and looked good. When my dentist drilled into the bone he said it was a little to soft inside for the implant. So he did another bone graft. I’m a week into it now. Not sure what to do next. Should I try again and do I need to wait longer than 5 months? So disappointed. Thank you Denise.

    Reply
    1. RamseyAminDDS Post author

      Although this is rare, your dentist did the right thing. Some people have bone so soft that I can flex it with my fingers! Soft bone should be given and extended healing time of 7-9 months for another attempt. This is much more common in the upper jaw that in the bottom but it can happen in that area also.

      There are techniques of compressing the bone rather than drilling it to make it more dense as the implant is placed. This is a technique utilized by a more experienced dental implant surgeon to change the quality of the bone during surgery.

      Reply
  58. Mary

    Dr Amin..I had peri implantitis surgery with bone grafting Oct. 31st. I started having more pain on around the 4th day, saw my surgeon 1 week followup and the reason for my pain was b/c the sutures inside of mouth, tongue side, came undone..Today I am still in pain, tylenol every 6 hours..but my concern is that there is bone showing and the there is a gap in the gum area.. My surgeon says I need more time to heal, so just want to make sure that the gums will eventually close up..doesn’t seem like enough gum to cover the exposed bone..tired of being in pain.. My surgeon says everything looks fine and healing well, just need more
    time for come to heal..

    Reply
    1. RamseyAminDDS Post author

      Only time will tell. It will likely take 4-6 months before you really know if this is working by taking a repeat x-ray.

      Bone grafting for peri-implantitis bone loss correction is typically not 100%. Hopefully you did not have a 360° “moat defect” as those have a very poor prognosis for grafting.

      Reply
  59. Donna

    Hi – I had a bone graft following a tooth extraction due to an abscess and fractured tooth. Tooth number 18 I believe (Bottom left last tooth). I did have wisdom teeth pulled years earlier. I was wondering, if I decide NOT to get the implant, if the bone graft will eventually become a problem? I’m hesitant because it is VERY expensive to complete all procedures. My dentists is asking 2000.00 for the next phase and another 2200.00 for the completion of the procedures. I can’t see spending this much money on a back tooth that no- one will see. They explained that it will mess up my upper tooth and my bite. Thank you for your honesty. D

    Reply
    1. RamseyAminDDS Post author

      You can have a bone graft without a dental implant although it does not serve much purpose except it may preserve the bone for a bit longer to have the implant done later in life.

      The lower second molar is very important. Want to lose it the opposing tooth #15 will drift out of its socket and he will eventually lose that 1 to starting the domino effect of tooth loss. It is a slow process but over time your bite will shift and bone will be lost. Nature gave us the second molars for reason and I would highly suggest that it is replaced.

      Reply
  60. Tina

    Hi Dr. Amin, Super concerned about getting a bone graft and replacing a bridge with an implant where the bone is REALLY has receded. Is that graft that fills up that space going to be uncomfortable for years until my body get used to it? The bridge that needs to be replaced was botched, doesn’t fit and is made of metal that I’m allergic to and burns my mouth every day all day. I have to clean underneath it after any bite of food I eat. It’s been a miserable year!

    Reply
    1. RamseyAminDDS Post author

      Just do your due diligence and research a really super dentist if you are “super” concerned. Have this done right the first time. 60% of what I do is often redo implant dentistry!!!!

      Reply
  61. Katie

    Just got my upper back molar extracted and prepped for an implant. Stitches broke after a week and a lot of white tiny crumbling pieces came out and are still coming out a bit. Dentist didn’t give me very much info of what they actually did. I now have a big whole and don’t see the dentist for a week, i do now have slight discomfort, should i be concerned?

    Reply
  62. Ari

    hello there Dr. Amin~

    I had a cracked tooth (previous root canal and crown) extracted approximately three months ago, and a bone graft done to prepare for an implant.
    The procedure was relatively painless, and seemed to heal quickly with very little pain. ( I did not need any painkillers after the second day.) I am supposed to return to the oral surgeon in a month or so (four months after the graft with cadaver bone) to get the titanium screw implanted, but two days ago, I started getting very intense pain in my gum/jaw. This pain has only increased, so much so that I started taking Motrin for it two days ago, and then, tonight, I had to take the prescribed hydrocodone (that I did NOT need three months ago) because the pain was so severe.
    When I feel along the inside gum (in the area next to/under my tongue) I can feel a sharp pokey protrusion, as if the bone graft is growing sideways through my jaw tissue. I am returning to the oral surgeon this week, but am now concerned about getting the implant done at all, and am curious about this sudden late pain (and the protrusion through my gum tissue) that is unbearable… :/
    I live in CA and might just make a visit to Burbank to see you and complete this…
    Any ideas of what may be going on? and is it unusual for sudden intense pain to erupt so long after the initial procedure?
    not happy with this turn of events~

    Reply
    1. RamseyAminDDS Post author

      Is it possible that it is another tooth in the same quadrant? Lightening can strike twice! If not it may sound like you have a bone graft spicule coming through the gum which did not quite integrate with the graft. A clinical exam and x-ray is indicated. Keep us posted placed in please reference you’re original email as they become hard to follow within the 100s of comments

      Reply
  63. Jaimee C.

    Thank you for doing this informative website; I wish you were my DDS! Question: I had an initial bone graft with implant, implant failed because bone graft became infected somehow, and now another bone graft in case I want to redo the implant; implant was removed at the same time. That was about three months ago and I’m still periodically feeling discomfort from the bone graft, and sometimes a bitter taste from it. I watched your video and realize its probably still healing (it’s lower jaw), and a scan from my regular dentist said it looked good. But why still the discomfort and the bad taste? In some ways it feels worse now then it did a month ago. It’s not a bad pain–just an off and on ache. And this bitter taste! Also, are redo’s likely to succeed or is there a chance whatever made the first fail could happen again.
    thank you.

    Reply
    1. RamseyAminDDS Post author

      Hmmm… There should not be any discomfort or a bad taste this far out. Do you have any health issues that was slow down your healing. Vitamin D deficiency, immune system problems, kidney problems, smoking, etc. etc.

      Please described the technique of bone graft you had done. The word bone graft is very vague.

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

      Reply
      1. Jaimee C.

        Thanks for such a quick response. The bone graft was cow bone composite. I had two previous implants, upper jaw, five years ago and the DDS used human cadaver–I had no problems with these. An oral surgeon did this current one that failed, and the failure had to do with the bone graft becoming necrotic somehow. There was also seemingly an unusual amount of pain with that implant recovery. Is it possible for my body to reject this kind of material? Again, the discomfort I’m experiencing now is not severe, but seems to be getting a little worse–particularly when I use the jaw muscle a lot. He had to attach it to the cheek, or the muscle there, something like that–I think that’s where the bone loss was. I’m not a smoker, no vit. D deficiency or other issues–very good health. Thank you!

        Reply
        1. RamseyAminDDS Post author

          Is it possible for my body to reject this kind of material? —-not really….. You probably had an infection that wasn’t completely visible. Sometimes antibiotics are necessary for second go around.

          Reply
  64. CC

    I had a sinus lift and a bone graft (bovine particulates) done in my upper left jaw in early June in preparation for two dental implants in December/January. I had facial swelling the day of surgery but after that, I had no pain, infection, or other side effects. After two and a half weeks, I went biking and small pieces of bone were coming out in my mouth. Since then it’s been fine. The X-ray done two weeks after surgery showed that I was healing nicely. But yesterday and today, I am having more particulates coming through. I am almost sure it’s through my sinus and toward the back of my throat since it only happens when I pull mucus through the back of my throat from my nose. I don’t have any pain, discomfort, or sinus pressure but I am concerned about these pieces of bone. Is this normal? It had been 8 weeks post surgery. I was avoiding eating on that side for a while but I am having bridge work done on the other side so I started eating soft food on the bone graft site. The particulates started with one piece at around 1mm sized. But now I am having multiple pieces adding up to 5mm or more. Should I be concerned?

    Reply
    1. RamseyAminDDS Post author

      hmmm….very odd. It is possible you may have overdone it a bit too early in the healing duration and perforated your sinus membrane from over activity after a sinus graft.… Or it is possible you had a small perforation of the sinus membrane at the time of surgery but usually by now that would’ve closed off or become more of a problem. Typically as the bone heals it will coalesce together as the membrane reforms. If you’re smoker this could slow down as sinus grafts require the small Cilia projections inside the sinus to clean it out. Smoking paralyzes are natural way of clearing the sinus. The x-ray taken should be a 3-D CBCT cone beam going all the way up to the base of your eyes to make sure the drainage holes are open

      Reply
  65. JJ

    Hello Dr. Amin,

    One more quick question, if I may: I have scheduled some dental work on teeth surrounding the healing implant site (see my previous post – I had extraction, graft etc. + implant same-day of #19). Now I need a crown on #18 and inlays on #20 and 21 in about 2 weeks. Will it be safe to have work done on all teeth directly beside my healing implant and graft? There will be plenty of drilling and pressure, and I’m worried it would disturb the healing of #19. Anything I should warn my dentist about as she navigates? 🙂

    Thanks again!

    Reply
    1. RamseyAminDDS Post author

      I would not do any dental work for at least 6-12 weeks in the areas adjacent to a recently placed implant and bone graft. Why the Rush?

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

      Reply
  66. JJ

    Hello, I just had tooth # 19 extracted due to infection below the root, and an implant with bone graft and tissue regeneration was placed immediately following the extraction – I believe I was in the chair for only about 30 minutes. This tooth had a root canal over 10 years ago, and recent x-rays showed a deep shadow enveloping the mesial root (chronic infection – probably been festering for at least 9 to 12 months, maybe much longer, but not “painful” just discomfort and smell during flossing). My main question involves the factors taken into account when deciding to extract, debride, graft, tissue regen + implant simultaneously. Can you recommend some reading on simultaneous vs. delayed placement (medical article that’s moderately decipherable by the man in the street would be nice, but academic articles work too). I’m interested in looking at some studies showing success rates, preferably long-term. So far, it seems that some periodontists are “pro” immediate placement when possible, while others are firmly “against” immediate placement in most situations.

    My surgeon clearly favors a simultaneous approach for my situation. I consulted a reputable specialist for a second opinion, however, and he told me that he would have allowed the bone to heal on its own for several months following extraction, before placing the implant. Can bone be encouraged to grow back without the graft procedure? Is grafted bone weaker than “naturally healed” bone?

    I had been on Amoxicillin 3 days prior to the procedure, day of, and 3 days following. Would it have been better to extend antibiotics for another week, since the implant was placed into a previously chronically infected site, with bone graft? I did begin getting whiffs of an unpleasant “infection” smell from the area the day after the antibiotics ran out. I have been very attentive to keeping my mouth and teeth clean. Today is day 10 of recovery, and pain is beginning to subside slightly – Hopefully it’s clear of infection, but to be extra safe, is there anything more I can do to prevent / fight infection?

    I will hold off on further questions for the moment — I greatly appreciate your time and expertise.

    Thank you!

    Reply
    1. RamseyAminDDS Post author

      The diagnosis and treatment plan for any immediate dental implant has to be carefully thought out. What is most important is that your dentist has a high level of experience and judgment on these cases. I do both immediate and delayed dental implants depending on each person and each tooth unique situation and bone anatomy. Immediate dental implants can be equally successful to delayed when handled properly and in a patient that heals well. Both techniques have their merits and sometimes one is better than the other but it is very much case dependent.
      .
      Bone will grow back on its own but it does not regenerate lost volume it only repairs the defect. If your leg got cut off, the end would repair and close up but the foot would not grow back. That is the difference between repair and regeneration.

      I would personally extend the antibiotics for a longer period of time after the extraction and implants.

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

      Reply
      1. JJ

        Thank you so much for taking the time to reply thoughtfully – Much appreciated! I wanted to update and tag one more quick question:

        It has been 25 days since my extraction – graft – tissue regen – immediate implant procedure, and I went ahead and had work done on the teeth surrounding my implant, at the assurance of my surgeon that it would be risk-free; He took my stitches out, said it looked great, and gave me a total green light for crown on 18, inlays on 20 + 21.

        But the result was major swelling and pain at the implant site for a couple of days following, and now I have what feels like a small marble beneath my gums in the area – which wasn’t there for the first 3 weeks of healing. Is it possible that pressure on adjacent teeth (especially on #20) pushed the bone graft material down to the side? Should I have this small protrusion checked right away?

        My surgeon tends to answer all of my concerns without even hearing them, (I think he has a recording for all patients that repeats, “Stop worrying, just let it heal.”) So I need advice on this 🙂 It was upsetting after 3 weeks of gradual healing to a point of almost normality, to suddenly be back to zero, feeling like I just had the surgery again (major pain, swelling, etc.).

        Thank you so much for helping so many patients who have questions and concerns. I have read at length in your blog and in the comments and conversations with others posting here, and all have been extremely helpful and informative. I will definitely recommend your work to anyone I know who is near So. Cal. (btw, do you do the abutment + crown?)

        Reply
        1. RamseyAminDDS Post author

          it sounds like you has some sort of breakthrough pain or bone infection. Hopefully by now it has resolved. Yes, I do make abutments and crowns quite routinely.
          😉
          Thank you for your very kind words

          Reply
  67. Gordana

    Hi dentis. I had a bone graft on existing implant 10 days ago. I have been told not to brush the area around the bone graft. Today I had a peek and I saw that I have a few layes of white stuff on my bone graft. I’m so worried and j have no idea what to do. Should I go ASAP to my dentist??

    Reply
    1. RamseyAminDDS Post author

      It is too early to tell if there are any major problems. White is normal healing inside of the mouth.

      this link should help you

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

      Reply
  68. Theresa Cox

    Im beside myself I keep hitting brick walls. I have a history of bruxisim, Crohn’s disease, I had a full set of titanium implants due to gurd and Crohn’s disease. I also had a fracture of the right 5th dip joint and a fracture of the right to fib titanium implants were used . I developed osteomyelitis of the right 5 th dip joint and the implant was starting to protrude to the right, the right tib fib implant began to protrude upward to the subcutaneous tissue all were removed and the bone healed up well. All my implants have failed and some are protruding bto the gum line. Because of the Crohn’s and its affect on the immune system I keep getting exacerbations with severe ulceration so in the mouth hard palate ,soft palate, ears, throat, sinuses, severe diarrhea with 28 pound wt loss. Also difficulty chewing due to having 6 imbutments and 3 implants with teeth. I have been in the hospital several times with upper and lower GI bleeds, shock, and electrolyte imbalance and dehydration. The oral surgeon suggests removal of the rest of the failing implants and bone grafting for severe lower gum bone loss. Because of bruxisim and other problems not quite sure what to do. Can you refer me to someone who specializes or knows what to do with a problem like this. I’m sick of not having any teeth.?

    Reply
    1. RamseyAminDDS Post author

      If you are not healthy enough to have implants you may want to consider not doing the procedure. It sounds like you have a bad history and may be asking for trouble. I know that’s not what you want to hear but sometimes no treatment is the best treatment.

      Reply
  69. Ellen

    Hi. I had upper teeth extracted with bone grafts. Two! It’s about three weeks and there is still a hole where the teeth were. How long does it take for the space to fill up and become flat due to regrowth of bone? I am worried bone material fell out. Your reply would be appreciated. By the way I have zero pain.

    Reply
    1. RamseyAminDDS Post author

      Usually the areas stitched with some sort of a membrane in order to cover it. Typically that membrane may dissolve on its own or be purposely taken out in just a few weeks. Techniques, training, judgment and experience vary from dentist to dentist.

      It is not uncommon to have a different bump in the gum until it fully heals. That does not necessarily mean that your bone fell out! I think you will be okay but see your dentist!!

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

      Reply
  70. Kathy

    I had bone graft and sinus lift 4 months ago. My sinus area never healed. Had it restiched 3 times ! Bone has escaped through this sinus hole. (If I use mouth wash it comes down my nose . ) instead of 3 implants, dentist said only enough bone for one remains. He closed the sinus once more but it’s open again… We Waite. Do you think the implant wil hold ?
    Kindest.
    Kathy

    Reply
    1. RamseyAminDDS Post author

      this is very odd. I would suggest you consult with a very experienced dental implant provider who performs the sinus graft routinely. I would suggest that a postoperative 3-D CBCT x-ray be taken to evaluate the area carefully. If the sinus has never healed which is extremely rare, I would not proceed with treatment.

      you may have developed what is called an oral antral fistula which needs to be taken care of before going forward with an implant

      Reply
  71. Melissa

    Good afternoon I had a question i am getting tooth #16 removed (wisdom tooth) and the dentist wants to put a bone graft in there why is that if i dont need an implant where my wisdom tooth is getting extracted?

    Reply
  72. Erma

    Hi Doc Amin,
    Good day, i am so worried of the wholes on my gum that has done implant and bone graft at the same time 1week ago. I came back to my dentist after a week as the stitch has got loosen and can see the graft expose so he did stitch again, 2days later the result now is that the bone graft that was expose before is now gone but it made a whole and makes me worried a lot, what is this sign please help. I am going back to see him on Saturday again.
    Thanks a lot for sharing ur knowledge to the people u are so nice giving all the advices in this whole world. May God bless u more!

    Reply
    1. RamseyAminDDS Post author

      Stitching open wounds a second time never helps. A very experienced implant dentist would typically not perform a re-suturing. It is probably better to remove the graft and allow it to fill in with gums and then start over again if it doesn’t heal properly or becomes chronically infected

      Reply
  73. Blake

    Good day Dr. Ramsey- Early this week I had my #9 removed due to infection. I had bone a bone graft done and my doctor said it would be 6-9 months before implant. Currently I am wearing the essix retainer and it is awful. My question is ” how long do I have to wait before I can have a temporary bridge made to replace the essix retainer while waiting for the bone to heal for implant? I believe my doctor said 3-4 months? I figured the bone and gum would heal enough in a month or so to allow for a temp bridge. Thank you

    Reply
    1. RamseyAminDDS Post author

      Your timeline sounds about right. There are other options for tempers such as a snap on smile but it depends on your current to tuition. Just ask your dentist.

      Reply
  74. Brooke

    Hi Dr Amin, I echo the others in thanking you for your insights and caring manner. I have ms and need to extract #’s 7 and 9, due to resorption. The bone there is quite thin so I was given two options to build it up, using Infuse or harvesting bone from my chin.

    After reading about the risks of Infuse, the tremendous swelling and potential for unwanted extra bone, especially since I have ms, I am considering the other option, taking bone from my chin. I would appreciate your thoughts on either option, and in particular, am wondering if the bone harvested from the chin completely grows back without any deficit or change from the original state, and how long this would take. Also if it is noticeable after it’s done. I am told the bone there appears healthy from the cbct scan. Thanks again!

    Reply
    1. RamseyAminDDS Post author

      I used to do many chin block bone grafts. There is a better way. Please type in block bone graft into the search bar on my site and that will help you.

      Reply
  75. Thomas

    I only needed a small amount of grafting due to infection but still had plenty of bone. They did not place the implant at that time how long am I going to have to wait for the implant to be placed.

    Reply
  76. Yanni

    Hey I’m 27 I just had my #21 and #22 Slots bone grafted after major bone loss due to a few years with a Marilyn Bridge.

    How long before I can actively start using that area again, its an awkward spot at the front of my mouth and Im worried I may affect the bone that was planted (bovine)

    Reply
  77. Susan

    Thanks for helping people like me! I had a bone graph using cytoplast and a implant on #29. The periodontist that did the procedure said the membrane failed during the procedure. He ask for cytoplast 3 times and had to screw a “tent” over the graph. Procedure lasted 3 hours and he had to reschedule 2 of his appointments because of “complications of my surgery.” I have had severe pain. Took Clindamycin and metrol Dose pack, ultram and Tordon and Advil for pain. I had my stitches out and told him about my pain he said it was a intense procedure and it may take a while to recover. I called back a few days later and went in. Ask for a x-ray. They did a ct scan and I had a infection and it is draining pus and clear fluid. The ct scan showed the bone graph had slipped and was on the nerve. He said he could clean out the infection but if he opened it up It may be worse. He said worse case he may have to remove the implant. Yesterday I called because my 7 days of Keflex 500mg tid was done and site had a little hole and draining clear fluid with a small amount of pus. He put me on Keflex another round and told me he thought it was residual drainage from the prior infection. I did sleep all night for the 1st time Sunday night and have been trying to deal with the pain and not take advil. Tonight I am hurting so bad I took Advil (I really hate taking meds). Should I get a 2nd option? Last time I went in I ask for a X-ray and they said if u have a infection the dr can tell he doesn’t need a x-ray. Suggestions?

    Reply
    1. RamseyAminDDS Post author

      New infections are visible in real and not typically viewable in x-rays. I would continue to see your doctor for the first 30 to 45 days and see how things go. Sometimes complications do happen even with an extremely skilled provider that is doing everything right. Of course I don’t know you or your provider or your situation but give it time and follow all the directions

      Reply
  78. Alex

    Dr. Ramsey,

    Thank you for the informative video. I do now understand how much time it takes on the average for the bone to heal after grafting. The question that I’d like to hear your opinion about is how long after grafting I can go without placing a post in the bone? The concern here is whether or not the bone graft will diminish over time if I delay the installment of the implant (say, by 1.5 years).

    Thank you

    Reply
    1. RamseyAminDDS Post author

      great question. It may or may not diminish over time depending on what type of bone placed inside of the socket. Your own bone or cadaver bone will turn over and become your own bone more quickly which also means it will dissolve more quickly. Synthetic or cow bone will take much longer or will never become your own bone. Oftentimes a mixture of different grafting materials is used in conjunction with each other to get the best of both worlds. Keep in mind that your other teeth may shift during the delay of treatment.

      Reply
  79. Estella

    I had a moler extraction and a bone graft with a mainbrain on March 2016 and my jaw sometime bother me. Could it be that my body I’d
    Is rejecting it. I have diabetes does it take long to heal?

    Reply
    1. RamseyAminDDS Post author

      as a diabetic, you can definitely heal much slower than the rest. It is important that you’re daily blood sugar numbers and your A1c numbers are as low as possible to help the healing process. Wide fluctuations in blood sugar will slow down the healing process and may cause infections and/or failures of the implants or bone grafts.

      Reply
  80. Helen

    What a kind man to spend your time answering questions from people who arent your own patients:)
    I had three implants in my upper jaw – to cover 4 missing back teeth and the tooth next to the front one. These teeth have been missing for up to 53 years! as they were removed when I was a child. At this time of retirement I thought I should spend some money on myself and have implants.

    The surgery went smoothly because of bone loss I had a sinus lift and bone graft and the three implants screwed in. Very little discomfort for 3 days and then quite bad tooth ache pains along the upper jaw. These virtually pased after 3 more days – my dentitst had put me on a 2 week course of antibiotics at the time of surgery.

    I have been back after 2 weeks to have the stitches removed and the dentist is pleased with the results. I did mention I am still getting a bit of an ache along my jaw and also under my eye/in my cheek is a bit sensitive to touch. He looked at the xrays and photos and said it would just be inflammation from the extensive surgery and will go.

    I am a worrier and though I think my dentist is lovely man and very experienced I keep wondering why after nearly 3 weeks now there is still a dull ache in my jaw and cheek. Is this normal please or should there be no pain at all after this time.

    Reply
    1. RamseyAminDDS Post author

      Thank you for your kind words. Yes it takes an extraordinary amount of time on nights and weekends away from my family to answer all these questions but I do enjoy helping others.

      Basically in the first month you may experience some pain depending on the extent of the surgery. Most people are done with pain by the 10th day but occasionally a mild intermittent pain may occur that generally will be gone by day 30.

      Reply
      1. helen

        Just to let you know that after 4 weeks I had no more discomfort, just as you predicted 🙂 .Im grateful for thereassurance you gave.

        Reply
  81. Alaina LeBrun

    I had a bone graft placed in my left premolar about 3 1/2 months ago with good healing and no infection. Over the last month or so it feels like my teeth next to the extraction site are moving. I feel like my tongue may push on them at night, but also randomly during the day I feel like they are moving as if I had braces on, but other times they feel fine. It does seem also like my bite has changed and I have more of an overbite with my incisor tooth as well as the tooth appearing longer. Is it possible that I am moving my teeth with my tongue or the bone growth is moving my other teeth?

    Reply
    1. RamseyAminDDS Post author

      Hmm. Something doesn’t sound right here. I would suggest an X-ray evaluation for periodontal disease on those other teeth.

      Reply
  82. Sarah Lambe

    Your website has so much information and is presented so well.

    I’m 38 and have 2 missing upper lateral incisors from birth. I was given 2 bridges as a solutions in my 20’s however one of them recently fractured and I have been given the option of an implant or replacing the bridge. I have decided to go with the implant route and have also elected to replace both bridges with implants/crowns because of the age of the bridges (15-20yrs) and because I feel that the aesthetics would be more unified if they were both done at the same time.

    I have sufficient height of bone, however not enough width and as such had a bone graft done this week. I’m told the heal time is 6 months. I’m quite swollen and bruised and wasn’t expecting the invasiveness of the procedure. I guess I’m looking for some reassurance that the implant was the better option. It just seems like a lot of work and expense when compared to the bridges. I just sort of felt that the aesthetics would be better with implants and also the long term costs might be the same given that bridges often need to be replaced.

    The bone graft is suppose to heal for 6months and the implant heals fro 3-4 months. Is this typical?

    Thank you in advance

    Reply
    1. RamseyAminDDS Post author

      thank you for your kind words. Grafting back the width of bone is much easier than grafting the height of bone. The upper jaw should be allowed to heal for an extended period of 4-6 months if the grafts were very significant. Letting them heal longer is much better than not letting him heal enough. Having dental implants and bone grafting is a short-term sacrifice for a long term benefit. Dental Bridges made in a conventional manner on natural teeth eventually fail and often take other teeth along with it worsening the problem.
      Not all bone grafts are created equal. A block bone graft is a much more significant recovery then just a standard socket bone graft. I don’t know what type of bone graft you had but these are just to examples of many techniques that I perform.

      Reply
  83. Rita

    Hi there so nice that you take time out of your busy day to answer concerns here. I had a tooth extraction #13 almost 3 weeks ago now and had a bone graft placed immediately after. The tooth was a failed root canal and had an abcess. After about a week it seemed to heal nice. I had the stitches removed 2 weeks after the graft and the membrane will be removed next week. The gum feels sort of puffy against my cheek almost like a piece of gauze is in my mouth. Is this normal or is it possible there is too much bone graft material? I thought maybe it may have been due to the membrane. Thanks in advanced for your response. ?

    Reply
    1. RamseyAminDDS Post author

      I wish there was more time in a day to do it all but unfortunately there is not!

      The swelling will go down and the area will begin to feel normal. Likely by now it is fairly well-healed and you should be approaching the time to place the implant which is oftentimes 4-6 months after the original extraction and or bone graft.

      Reply
  84. Karen

    I just had a bone graft done, should I be taking antibiotics? I was only prescribed Ibuprofen and Norco.

    Reply
  85. Mike

    I had a #14 extraction with bone grafting done 13 days ago. The sutures came out on post op day 7. I have a small area that is white in the hole where the tooth once was on the chewing surface of the gums. Is this the bone grafting material I am seeing? I still get a few of the tiny bone graft particles in my mouth. How long does it take for the gum to cover the bone graft?

    Reply
    1. RamseyAminDDS Post author

      There is an article specific to your question about bone graft showing. Just search the site and you will find it.

      Reply
  86. Kathy Ward

    I had a bone graft and sinus lift almost 3 months ago. I seemed to heal well at first. The stitches drove me mad after a while. I got an infection ( bad taste etc) and was given three courses of antibiotics. The graft did not heal well and I had a little sinus hanging down.. I had the would restitched, but that never closed it either. I am almost 3 months on.. I have no pain, no swelling.. nothing. The sinus is not always showing, but sometimes comes out about the size of a cotton bud. I will see dentist in two weeks. What do you think ?

    Reply
    1. RamseyAminDDS Post author

      Wow. This is very odd. It sounds like you have a sinus perforation communication. These can be fixed by stretching tissue from your cheek to cover the hole. I assume you have had a few scans to verify? This doesn’t happen often at all but is a known risk.

      Reply
  87. Sandy

    Hello Dr Amin,
    I had a molor on the lower right extracted on 3/24, it had a stress fracture. A bone graft was placed right after extraction. I started experiencing a horrible taste in my mouth, extreme nausea and fatigue. I went to medical doctor who prescribed Augmentin and Zofran. I have completed the 10 days of augmentin; and the zofran has only helped minimally with the nausea. I have called the dentist office to find out what type of a graft was implanted. Wondering about possible rejection? I do have rheumatoid arthritis and take an immune surpressing drug. I am at my wits end with this after 17 days, dentist removed the sutures on the 6th gave me a referral to a peridontist for evaluation of molor #18 (has crown and most likely also infected) gave me a bottle of peridex rinse to use twice a day. I don’t know what to do, medical doctors don’t like to get involved in dental problems.

    Reply
    1. RamseyAminDDS Post author

      If the medication you are taking is called methotrexate it has a known reaction with Augmentin which could be the case. If not you probably just have a coincidental flu like I currently have and this too shall pass. It does not sound like dental.

      Reply
  88. Alex Swan

    Hello Doctor. Thanks for the service you provide here.
    I have bone graft 10 days ago on my lower jaw, #22 and add of gum on #21. The graft was done to save #22. I have been on antibiotics 2/day for 10 days. The swollen went away but I steel having some minor disconfort/pain. When the pain should go away? Should I be concerned? Also, for some reason after the surgery I found my front teeth loose. Why is this? Thanks.

    Reply
  89. Lisa

    I have neck pain and cracking after a dental bone graft. It is only on the side of the graft , the bone graft was on the left lower left jaw, and began after the graft. It’s been 4 mos. and cracking and pain are same every day. Will this ever go away?

    Reply
  90. keith thompson

    My dentist prescribed steroids after my bone graft. I had an abscessed tooth that previously had a root canal. He pulled the tooth, debrided the abscess and packed it with bone graph granules that he mixed in a cup. He prescribed antibiotics and steroids, I would rather not take steroids. Being that I already had an infection I’m concerned about using steroids as I know they can weaken the immune system and can have some negative affect on new bone formation. In your opinion are steroids necessary and would there be any problems that may arise if I decide not to take them? I asked him why I needed steroids and his answer was unclear but I think he was suggesting that I could have a rejection reaction to the graft material and the steroids would help with that. is this possible?

    Reply
    1. RamseyAminDDS Post author

      The steroids prescribed by a dentist are a much lower dose than those that would inhibit the healing process. Steroids have a tremendous variability in dose. They are extremely helpful and I would not hesitate for a second to take it myself for a surgical procedure. It definitely enhances the healing process.

      Ramsey Amin DDS

      Reply
  91. asa olsen

    Great video clear yet concise. 🙂
    Pain in bone graft recovery
    1. which is more painful to recover from..bone grafts to upper or lower jaw?
    2. does a simultaneous sinus lift increase pain in recovery? &/or prolong recovery time?
    3. is block bone graft more a painful &/or prolonged recovery than particulate bone graft?
    Of course it doesn’t hurt the dentist:) It definitely hurts the patient.

    Bone choice
    I understand that different bone graft sources are chosen depending on the area & patient status. However, in your experience Doctor, which type of bone have you seen to provide the best results as far as solid integration with the patients natal bone please?

    Reply
    1. RamseyAminDDS Post author

      I would suggest that you search my site for more information. Your questions are wonderful and have already been answered in numerous previous posts. I will try to direct you to some of them but just use the search feature.

      The lower jaw in general tends to have more pain.

      bone graft materials

      a block bone graft requires more recovery that a particulate bone graft but keep in mind the are used to reconstruct completely different types of defects and are not necessarily interchangeable.

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

      Reply
  92. C.J. Bohrer

    After 25 yrs. #8 implant failed. Failed implant removed. Cadaver bone graft installed 03/09/16. Adjacent tooth #7 used to help stabilize graft at site #8. Amoxicillin 500mg 3x’s/day used 9 days. SaltH20 rinse & clhorhex. used assiduously as prescribed. Persistent swelling & discharge of clear, noxiously-odiferous fluid (sometimes blood-tinted) still occur from graft posterior. Mild daily fever early a.m. Upon scrutiny university prof. and student say (as of yesterday, 12 days later) that healing, site and discharge are normal. Non-dissolve suture remains intact despite my removal request. I am uneasy about circumstances and considering a different periodontist. Comment most appreciated.

    Reply
    1. RamseyAminDDS Post author

      I would probably extend the length of your antibiotics for a second go around. You likely have a low-grade infection. If you’re diabetic, smoker or have any sort of compromise of your immune system that may slow things down. 25 years with a dental implant would be considered a success. I’m sure things will work out for you the second time.

      Reply
  93. Debasish Goswami

    Sir i am now 28years old boy.My rightleg top of toe and frontside bone fractured and some area dust and gap present in this area.Before 6 month 1 opertion done and not heal that area which was dust.And than 2nd operation done with bone grafting cuttin from my waist. I want to ask now how many days it will take to completely heal as it is too late.Also sir suggest me sir what type of food i have to take.pl help me sir

    Reply
  94. Tom

    Hi Dr Ramsey,

    Thank you so much for taking the time to answer all of these questions. I read thru most of them and your answers are very enlightening.

    I’m now 58. My front teeth were damaged when I was 14 tooth #9 went thru root canal, post installation and cap (post still intact). Tooth #8 was lost and tooth #7 damaged…at the time a bridge was placed from #7 to #9…but #7 is not a strong tooth and bite was challenging so it didn’t last….Finally, in my 20s tooth #6 was ground down and a new bridge including #6, #7 and #9 was installed. this held up for a while but tooth 6 developed a leak in my 40s and a red spot persisted in the gum above tooth #7 (infection). I recently opted for bridge removal and implants at #7 and #8 (Tooth #6 was still ok, cap and tooth were cleaned up and cap was reinstalled (fits better as individual cap). I waited 8 months after #7 extraction…gum healed fine…3D x-ray of area showed a reasonable amount of bone but a graft was performed at time of implants on one tooth.

    Here’s my questions:

    1. After 2 months there is still some tenderness on the roof of my mouth directly behind location #7 (was much worse a month ago…seems to be slowly improving…any ideal what that might be?)

    2. How long after implant surgery should I wait until having the abutments and crowns installed?

    3. Also, at #8 implant I can see a very thin red line going along the top of the implant into the area where gum meets facial skin. Is this a small blood vessel, anything I should be concerned with?

    Thanks Again!

    Reply
    1. RamseyAminDDS Post author

      hello Tom,

      Thank you for your very kind words. Your questions are very specific and I don’t feel like I could answer them accurately without seeing you.

      You may want to consider taking another 3-D scan during the healing process. Most skilled implant dentist will have a 3-D scanner in their office and will not charge you for follow-up scans

      Reply
    2. Tom

      I understand thanks…more generally, with the bone graft and two implants is it better to let the implants fuse to the bone longer before installing abutments and caps or sooner.

      The surgeon thought 3 months was the right time frame…but I have to travel near that time and was wondering if I’d get better results waiting another month or so more allowing the implants to fuse longer, or getting them done at the 3 month mark and working the new teeth while the fusing continues…

      Reply
  95. Sheryl Infantino

    I had a bone graft in my lower jaw first molar. I opted out of antibiotics due to my adverse reactions to them. 12 days later, the outer area is red and sore. when pushed on it still bleeds. My surgeon has checked me 2 times and says there is no infection. Due to a bad taste he removed the stitches on the third day. I have a open wound now as some of the bone graft materiel has crumbled away.
    I wear an essex in public which does irritate the gum tissue.
    I am flushing the area with warm water, warm salt water, colloidal silver, clove oil and mouth wash. Is this normal to be sore and still be bleeding?

    Reply
  96. Rachel

    Hi,

    Can you please assist. I am having the removal of an impacted canine (UR3) as I have been having Orthodontist treatment for the past 10 months and the tooth has not come down, it appears to be fused to the bone (I am 38 yr female).

    At the same time I am having bone augmentation to wider the area as the width of the gum is not sufficient for an implant. They are using bone from my lower jaw. I am having this procedure completed under GA in the UK.

    Can you please confirm if I should be discussing gum grafting as this was not mentioned by my maxillofacial surgeon?

    Many Thanks

    Reply
  97. Courtney C.

    I had a tooth extracted one week ago (a tooth that had a root canal that became infected/decayed). I also had a bone graft afterwards. It was the top right last tooth (they called it the sinus?). It seemed to heal quite well in the past week but a couple days ago I felt like something was stuck there (like food) and I put my finger back there and out came white stuff that smelled extremely bad. I am on Amoxicillin since right before the surgery and still taking it as well as rinsing with salt water daily. I took a flashlight to look back there and I do see the bone graft (I think) sitting at the top of the gum area but in the actual extraction site, I feel like there is white stuff sitting there. When I put a clean finger back to check if food and then take it out, my finger smells extremely bad. Is this normal? I called my oral surgeon’s office and they told me not to worry unless I developed a fever or swelling. What could be causing both the odor and white stuff? Worried. Grossed out.

    Reply
  98. Erica Avila

    Hi. I have a question. I had 3 teeth extracted 2 weeks ago. I just had stitches removed Thursday. The flap doesn’t feel all the way sealed yet near the back of my mouth and I was wondering if it will ever seal/heal? Im afraid it will open little by little. Should I be concerned? What can I do to seal it?
    Thank you in advance

    Reply
    1. RamseyAminDDS Post author

      Nature will close the wound for you. It will feel/heal. Some bone grafts are intentionally left partially open with purposeful membrane exposure. Read this post about membrane healing and you will probably understand more about it. Thank you for the question.

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

      Reply
  99. Amy

    Just had a 12 yr old implant of my farthest back lower left molar removed after I started experiencing pain when chewing about 6 weeks ago which got progressively worse. CT scan showed big infection and significant bone loss around implant. When my dentist was removing the crown, he was able to pull the whole implant out with just the dental tweezers! There was a little bit, 3 mms x 2mm, of the prior bovine bone graft stuck to a small part of the implant which was otherwise, just the screw! The stuck bone was sort of crystals/crumbly. He cleaned out the infected area, obtained bone from jaw area behind, inserted new implant and packed my own extracted bone around it and then packed cadaver bone around that. He has had my blood drawn and “spun” to get cells to use ( if I understood correctly). Now he said we wait for four months then install abutment. My concern is whether he should have waited the four months before even installing the implant because everything I’ve since read, seem to indicate installing the new implant after the bond graft has “taken”.

    Reply
    1. RamseyAminDDS Post author

      Hi Amy,
      it sounds like you are in very skilled hands. There are times when a new implant can replace a failing dental implant on the same day with a simultaneous bone graft. It also sounds like you had PRF/PRP treatment in order to enhance the healing of the area. If the area is ideal in every circumstance then same day treatment can actually be the best option. Sometimes it is best to wait but without a full exam, 3-D scan there is no way for me to tell you that.

      You might want to wait a full six months rather than four months to restore the tooth.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology

      Reply
  100. Sophie

    Dear Dr Amin

    My #22 tooth has a severe bone loss. It is very loose as if you can easily take it out by myself. Since the gum tissue surrounding it has significantly shrunk, the gum line is very very low.

    I asked whether I need rescue it and have bone grafting or not, and the periodontist said he could not tell before he open and see it. Then on the day (mid Jan 2016) that he opened it, he said he would do bone grafting for it because he felt I wanted to rescue it, but the hope is little because of the vertical bone loss. He used the bone from human, which I don’t know whether it is safe in terms of health.

    #22 is in the front area of the oral , and I found I can not avoid disturbing this tooth almost all the time, especially when I speak, when I swallow saliva or eat food, or when I swish water to clean the oral, etc.. I am trying not to speak at all every day, which makes me feel bad.

    Right now, I just feel I wasted my money , because there is such little gum left surrounding the tooth. Why didn’t the doctor do tissue regeneration at the same time? Wouldn’t that make the bone grafting have more chance to succeed? He didn’t do tissue regeneration because I didn’t mention this word and he forgot this kind of operation?

    Reply
    1. RamseyAminDDS Post author

      Bone is tissue also. A lot of this is just nomenclature. The tooth was severe bone loss, that is loose would be better off extracted.
      Bone grafts do not work around loose teeth unless they can somehow be tightened by splinting or adjusting the bite. You would likely be better with the dental implant.

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

      Reply
  101. Carol E, Thomas

    I had a bonegraft on tuesday and still getting pain How long does it take for the pain to go away I have taken everything I can think of I can’t seen to find a answer Thank you

    Reply
    1. RamseyAminDDS Post author

      It is quite variable based on surgical technique, your ability to heal and the difficulty of the surgery but most people are pretty much done by 7 to 10 days.

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

      Reply
  102. j torres

    I had a bone graft done about 1 week ago. It looks like there is a big hole with white stuff inside and all my stitches have dissolved. About how long does it take for the hole to close up? It was one of my molars..

    Reply
  103. hector

    hi,

    i just had a bone graft last January 16, 2016. Its been 2 weeks and my first 3 days looks good. I had swelling on my face on my first week and its gone but the second week my gums went flap like it went down to my teeth and I had a bad breath. Is it normal?

    Reply
    1. RamseyAminDDS Post author

      I’m not sure I totally understand your question. I would make sure to see your dentist for a follow-up visit and make sure you do not have an infection.

      Reply
  104. Milly Heider

    Had a tooth extracted and a bone graft. Have had nagging pain in jaw and area where tooth was extracted. Doctor said ( upon third visit) that I was healing fine and he saw no infection. He had never in all his years of practice had anyone have problems. He put me on amoxicillin for a week. After a few days pain subsided. Have been off meds for three days and jaw pain is coming back. Any advice would be appreciated. Doctor made me feel like I was making up pain. What should I say when I call him again?
    Thanks!

    Reply
      1. Milly Heider

        Hi Doctor, went back to doctor because pain continued and he did 3D scan. Told me I was not a candidate for implant because I had an issue with bone thickness and jaw.
        I left confused and called the dentist who sent me to this doctor. He sent me back ( after speaking with oral/maxilla facial doc) and he did exploratory surgery and found nothing. That was two weeks ago. I still have pain in jaw below where tooth was extracted and bone graft was placed. Now I can’t have implant – feel like All that money was wasted. Just want the throbbing pain along jaw and under extraction to end. Any help would be appreciated.

        Reply
        1. RamseyAminDDS Post author

          maybe see someone else. I have replaced many teeth that others said were impossible to replace.

          Reply
  105. Mrs. Torres

    Hi i just got tooth number 30 extracted from a failed root canal. My dentist gave me antibiotics for a week before. Should i ask for more because he didnt
    give me any after the procedure. Thanks

    Reply
    1. RamseyAminDDS Post author

      No. Unless you have a bone graft done it is unlikely you need to continue on antibiotics or unless you have medical conditions, infections and other problems.

      Reply
    2. Mrs. Torres

      I got an extraction and then the dentist did a bone draft afterwards. But he didnt give me antibiotic because he said that he had given me some a week before the procedure. I went back the day after to check on it and he still didnt give me any. Could it get infected ? thanks

      Reply
  106. Apple Lucero

    I had a resection of my mandible and bone graft 11days ago. My stitched was open and can see the bone but the doctor never stitch it back for me he just say to way until monday and let’s see. He just advised me take antibiotics. I am just a little worried about this things and I cant sleep at night that there my might me an infection.

    Reply
    1. RamseyAminDDS Post author

      Resection?? Are you sure?? That is usually A hospital procedure where part of your jaw is removed

      Reply
  107. David

    Hi there,

    I had a dental implant put intooth 5 area six months after extraction with a bone graft on the front for cosmetic reasons due to the position of tooth and subsequent bone ression. There was an infection around the old tooth as i had let it rot down as i couldnt afford implant at time and used to keep bone from receding. There was a seep hole where pus used to gradually ooze from over a period of a few months which turned into a minor crevasse just to the right slightly over tooth 6. When i got i fection cleared and tooth extracted it healed but possibly not thick gum anymore. Last night i awoke to bleeding in this area and gaused it and went back to sleep. Today, it started to seep again but this time the grafting material was making its way through this seep hole ive tried to gause it but as the grafting material is there is not sealing and clotting properly? I rang the periodontal clinic where i got the procedure done and they said excess seepage is normal. Is it normal this early on And if so when will it stop?, its not just one or two bits its a few bits of bone material an hour and i`m worried im going to lose the graft as the surgeon didnt know about the infection seepage point during surgery as it had been six monhs of healing and i didnt think it relevant. The area where the bone graft was put in is fine and the stiching is holding up well. How much seepage if any should i be expecting at this stage and if i cent get something to clot fully how do i stop it?

    Reply
    1. RamseyAminDDS Post author

      The only way to stop this seepage is for the area to heal on its own. My guess is it stopped after 24 to 72 hours. It is not uncommon in some complicated areas that a second bone graft is necessary. The first bone graft preserve the socket and the second one rebuilds areas that were missing to begin with.

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

      Reply
  108. Mrs Eileen E McInnes

    I have had my implants, about 4 months ago. I had a bone graft 9 thJan2016.my stitches come out next Tuesday. I then must wait 4 Months until it heals. When is it safe to fly? Must I wait four months,before I can fly?

    Reply
  109. Mary

    I started with the beginning of an implant three days ago. #30 removed and cadaver bone installed. At the time, the dentist said he had to remove some inflammation. What does that mean? Infection? Should I be concerned about infection developing? How soon can I resume aerobic exercise, i.e., walking steep hills and swimming?

    Thank you.

    Reply
    1. RamseyAminDDS Post author

      returning to normal activity would be a question better to ask your dentist in your situation. Inflammation/infection is commonly found at the bottom of a bad tooth that is extracted. inflammatory tissue looks like uncooked prime rib!! that needs to be curetted from the socket when a socket preservation bone graftthank you is done which sounds like a procedure you had..

      Reply
  110. Steve

    Hello, I had a socket bone graft done 20 days ago. Procedure code is D7953. Tooth number 8 was extracted about 2 months prior with intention of future implant. My bone had width, but insufficient height, therefore requiring the graft. The graft material (cadaver) was placed along with a membrane since the socket front wall was lacking. It was then sutured. I had my post-op 10 days later and things looked good and only a few sutures were removed. A few days ago, 17 days after graft and after my post-op, I started noticing a ‘click’ or ‘snap’ feeling in the site area when making certain mouth movements (i.e. puckering to a glass of water; relaxing a grin or smile). I’ve been very diligent with post-op care. Any thoughts? Thank you.

    Reply
    1. RamseyAminDDS Post author

      The upper front teeth help in speech development but what you are describing is odd. Perhaps your temp is causing this but I would not say the graft would do this.

      Reply
      1. Steve

        Thank you for the reply. I have refrained from wearing the Flipper post op during the initial healing process and still have not yet put it back in for three weeks now. Could it be the gum tissue healing and while I make any facial movement that it is stretching and causing the graft to move or damage which would make the ‘click’ / ‘snap’ feeling?

        Reply
        1. RamseyAminDDS Post author

          any bone graft that moves will fail with 100% guarantee. It may be just a feeling but I doubt anything is moving. I would take another 3-D scan at this point if my patient had unusual symptoms or the potential of graft failure

          Reply
  111. Alexandra

    I had an upper right molar, 2nd from the last, pulled after my crown fell off and was given a bone graft 10 days ago. I had no pain other than a slight headache at night. Everything was going great till today. I wear a mouthguard, shallow so it doesn’t come near that area, and it was layered with blood this morning. With every oral rinse now it’s pink from diluted blood. I can taste it so it must be seeping. I only eat soft food so that can’t be a problem. I have an appointment to get the stitch out Thursday (today is Saturday). Is this normal or should I call the dentist on Monday?

    Reply
    1. RamseyAminDDS Post author

      This is not completely uncommon being only 10 days out. The gum and bone are still in an infantile state and can be easily disrupted causing minor bleeding. Let me know how things work out.

      Ramsey Amin DDS

      Reply
  112. Peter

    I had my upper (impacted) bicuspids removed via surgery, the holes were filled with granulated bone. I immediately noticed a lump on my palate after the surgery, it has been 2 weeks now and that lump has not gone down or contoured back down. Is this normal and if so how long until the bone graft will start to recede? Is it possible that too much bone was placed on the extracted site? Implants will be placed after healing, bone was also placed where implants will go.

    Reply
    1. RamseyAminDDS Post author

      The lump is likely a good thing. Having additional bone is always a good problem to have. Oftentimes to graft is placed slightly larger than needed because it will undergo a natural shrinkage within the first 4-6 months. If it was a soft lump it could be an infection that would require drainage and significant antibiotic treatment.
      Keep us posted on your healing.

      Respectfully,

      Ramsey Amin DDS

      Reply
  113. Charlotte

    You’re so helpful answering all these questions. Thank you for giving so much time to helping all of us.

    When I was 12 I broke my two front teeth, when I was 15 they had to give me a Root canal in #9. When I was 19 the cap came off and a terrible infection was discovered. They cleaned it and recapped it, it was fine for ten years. At eight months pregnant there was an infectio in it again and the tooth broke above the gum line. My regular dentist extracted the tooth and placed a graph (bovine) it didn’t take, so they placed more and it still disn’t take. He referred me to a specialist who just did a bone graph (taking the bone from the back of my jaw this time) five days ago. BUT now I have a very active 10 month old who occasionally bumps my mouth…obviously I’m being as careful as I can but how would I know if it’s bumped too hard?
    Thank you.

    Reply
    1. RamseyAminDDS Post author

      I have kids and puppies too….they sure do bump us a lot!!

      I find it very strange that your original bone graft did not take. It sounds like you had a socket bone preservation graft. Typically those would not be done with 100% cow bone **if** an implant is being placed into it in the future. Cow bone is excellent for adding additional bulk and contour or adding it at about a 20-50 percent ratio with human bone. Of course I don’t know your exact situation though. I use cow bone combinations all the time and it is extremely predictable.

      Was the bone they took in the back of your mouth a block graft or just bone shavings? Using 100% of your own bone is also another problem because believe it or not it tends to shrink too fast!!!!!

      This post about block grafting may help you understand a little bit more about the process and bone types. As long as your little one does not hurt chew your not likely to have any problems from your child bumping into you.
      Respectfully,

      Ramsey Amin DDS

      Reply
  114. Monica

    Hello I have gum disease in tooth number 7 I have done root scaling but my gum disease has gotten worse and now I have a pocket of 5 my tooth is still strong and it has not become loose can I do bone grafting even if I’m not doing an implant I want to save my tooth? I have made an appointment but won’t be able to see you until February and I just don’t know if I could wait that long ?

    Reply
    1. RamseyAminDDS Post author

      Yes, bone graft can be done around existing teeth to reduce the pocket and save the teeth. I am looking forward to meeting you.
      Respectfully,
      Ramsey Amin DDS

      Reply
  115. Amelia Louise

    Dear Dr Amin,

    I had a bone graft 1 month ago to my upper jaw (right canine never came through so very thin jaw here now I’m 33 years of age). Donor site was lower jaw & this was added to bovine material & held in place with titanium mesh. A bridge was placed 2 days after. I had antibiotics for 2 weeks. Non dissolvable stitches were used & removed after 10 days, with two under the bridge left in (until implant placement in May). I still have some slight swelling around the side of my nose but have most recently noticed the gum over the graft site is thin in one area; so thin I can see the titanium showing through (using a powerful mirror & light) is this a sign the gum isn’t healing? Is there anything I can do if so? Thank you so much for any advice!

    Reply
    1. RamseyAminDDS Post author

      It sounds like everything is being done on the right way. It is not uncommon to see the titanium through the gum. Many females have very thin gum which is see through. Be sure not to rub the area at all and it should heal very well

      Most titanium mesh reconstruction grafts take a good 6-9 months to heal. This is a very advanced type of bone graft. I do this procedure and also the block graft which is very common in my practice in Burbank. Both of these methods can add a tremendous amount of bone very quickly.

      Keep us posted on your healing.

      Respectfully,
      Ramsey Amin DDS

      Reply
  116. Tom

    Hello Dr. Amin,

    I had a large cyst removed from around #10 two years ago and following bone grafting, too much scar tissue had developed around the tooth and prevented bone fill. I had #10 extracted (plus a lot of scar tissue) on Monday. Oral surgeon put in bone graft and said it’ll be at least 6 months before implant surgery, assuming adequate bone fill this time. Dentist made me a clear (Essix type) retainer which he says I’m yo wear 24/7 to help hold the bone graft in place and encourage healing. My swelling and pain started to reduce yesterday and are bring replaced with this terrible constant itching of my gums, caused by the retainer. I know it’s coming from the retainer as if I take the retainer out I no longer have that itching sensation. I’m hoping the dentist can correct the retainer on Monday (he is out for a long weekend….urgh!) but if he can’t adjust it to help my gums not itch all the time, what other options do I have? I can’t live with the itching for another 6-12 months….it’s driving me crazy in just two days! Thanks for any insight you can give!

    Reply
    1. RamseyAminDDS Post author

      Hello Tom,

      I am not a fan of leaving any device in 24/ 7. I like the Essix bridge but I do not have my patients sleep with them in place beyond the first week. All removable temporaries harbor bacteria and cause inflammation. You can also get gum disease and decay on your other teeth while you are wearing this thing 24 hours a day. I do not have my patients ever do this. In the presence of inflammation, bone grafts and dental implants are always at a disadvantage.

      What your dentist is trying to do is avoid you losing the “triangle of gum.”. This is the papilla and general arch shape of your gum. Because this is a front tooth, it is easier to keep this than to rebuild it. Keep in mind that is rebuildable if it is lost as long as the teeth on either side are healthy.
      You can also switch temporaries altogether to a stayplate that has a “ovate pontic.” Here is an article on the ovate pontic that you can used to understand at least a concept which can be used in a temporary bridge also.

      Front teeth are very difficult dental implants to make them look great. It would be great if you had the same dentist doing the surgery and making the tooth. Consider finding somebody with similar qualifications to me who may be able to do the procedure all away through and make immediate fixed temporaries which would help sculpt the gums back to original.

      The quickest solution is to remake a different type of temporary. Sometimes the Essix bridge is better if the type of bone graft was a block graft or membrane guided graft rather than just a classic socket graft.

      I hope this helps you

      Respectfully,

      Ramsey Amin DDS

      Reply
    1. RamseyAminDDS Post author

      Ideally asap, but 2 days in advance and for 5 days after a major reduction must occur…you dont want complications! This would be a great time to quit forever. Depending on the extent of your graft, you may not be able to smoke at all…for example, a “block graft or sinus graft” is a much bigger deal than a socket graft. The technique is a big factor. If you have other medical conditions that only makes things even more risky.
      You can do it!
      😉

      Reply
  117. Rick

    Hello,
    I recently had #30 extracted(root canal tooth) and was going to get implant but had to do a bone graft and wait 3 months for implant. It is day 9 and I notice some white material like substance with a little dot pattern on it coming up through the gums near the edge of the stitches area. I’m assuming its the membrane. Is this normal? I’m still on 800mg ibuprofin every 6 hrs (start feeling it around 5-6 hrs) and 95% of the swelling has gone down.

    Reply
  118. R. Richardson

    I had bottom left first molar extraction, bone graft, and gum surgery ten days ago. I’m still having some pain, but it’s managable. However, yesterday and today I’ve had more chips of the bone graft appearing…in the first eight days I had, maybe, three or four chips, which I read was normal, but just today (it’s 10:21 a.m.), I’ve found five! Is this something about which I should be worried? Thank you for any advice you can give me.

    Reply
  119. Pete Brown

    Hello, Thank for helping so many people! I had a surgical removal of erupted tooth, #12 removed and a cadaver bone graft, the doctor called it a building block of a bone, on August 26. On Dec. 1, 2015, the doctor examined the sight, and took a cone beam CT X-ray to determine that I was ready for the implant to be placed. After watching your video, suggesting 3-4 months time for healing and growth, I am concerned that enough time has not passed for proper healing or bone growth. I like my doctor and I trust his judgement, as he had been in business for well over 20 years and his reputation is great. Is my worry warranted?

    Reply
    1. RamseyAminDDS Post author

      letting it heal a full 6 months will never cause a problem. Better overcooked than under cooked 😉

      Reply
  120. Alex Kretz

    I had a block bone graft taken from the “wisdom teeth” area about 2 weeks ago. The graft site is doing well and there is little pain (#8 location). However the donor site is still killing me with pain. I have gone through 2 bottles of narcotics and 1 round of amoxicillin. How much longer should I wait to become concerned with the pain not subsiding. I just saw my dentist and he said everything looks amazing as far as a healing standpoint but this pain is killing me.

    Reply
    1. RamseyAminDDS Post author

      Hello Alex,

      What you had is an autogenous bone block taken from the ramus buccal shelf. I use to do this procedure extremely commonly until I moved towards using bone from a cadaver rather than bone from yourself. See this specific blog post on block bone grafting to learn more about this option.

      As for your issue, I would suggest taking a panoramic x-ray or 3-D scan to diagnose any problems with the donor area. In very rare instances the jaw can get very thin and fracture. If that were the case he would have significant pain but the Hallmark would be the feeling that your bite does not come together properly. It is unlikely this is the case but should be checked. I did this procedure for at least 12 or 13 years and I never had a patient that had pain for 2 weeks after to the degree that you’re describing.

      Keep me posted please. I would like to know the outcome. Be sure to give detailed references or cut and paste your original post so that I know our original conversation.

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

      Reply
  121. Jan Cooper

    I had my bone graft on July 19th, and it is very slow in healing. My dentist opened it up again two weeks ago to see what was going on as it was slightly infected. I have been flushing it out with a diluted mixture Chlorhexidine Gluconate oral rinse after each meal. There is still a visible hole at the front and i can see a small portion of the graft. I am scheduled to have cataract surgery tomorrow. Is it safe to proceed with it? And is there anything I can do to speed up the healing?

    Reply
    1. RamseyAminDDS Post author

      There isn’t much you can do to speed up healing. I assume you are already in the proper antibiotics based on your medical and surgical history.

      Cataract surgery should be fine but I would ask the Opthomologist.

      Good luck.

      Reply
      1. Jan Cooper

        Thanks for your reply. I went ahead and had the cataract surgery and it went well. Have antibiotic drops to apply for a month, which is good. I will talk with my oral surgeon about my problem, but I appreciate your feedback.

        Reply
  122. Denise Clark

    Hi, I had a bone graft done in May in preparation of a tooth implant. I rescheduled the implant to December because I just don’t have the money. I need to reschedule again but I’m embarrassed to ask my doctor. How long is safe to go before I have to have the implant done without causing any problems with the missing tooth and the bone graft?

    Reply
    1. RamseyAminDDS Post author

      It depends on what your dentist grafted your bone with. Some types of bone start to shrink and dissolve faster than others. For instance, your own bone dissolves the fastest while synthetic bone doesn’t dissolve at all. Often a combo of cow and cadaver bone is best for bone formation and long term stability.

      Don’t be embarrassed to ever ask your doctor anything!!

      Good luck.
      ????

      Reply
  123. Gary Vannatta

    I had extraction of tooth and bone graft to get ready for implant. It is day 4, area was red and then black and now white, and also pain yet in area of the extraction and a little swelling yet. Is this normal?

    Reply
    1. RamseyAminDDS Post author

      It sounds like things are on course. The color is a bit subjective though. White is considered normal healing in the mouth as long as there is no fluid that is white coming out of the socket.

      Reply
  124. Peter Simcock

    Hello Dr Ramsay,
    Perhaps it has been missed or overlooked, but I egarly await your comments I’d made about sinusitis (and what could be done if caused by dental implant surgery ) posted on September 26th.

    Thank you,
    Peter Simcock

    Reply
  125. Mohammad Shamaseen

    I did bone grafting 8 days ago , it is in the chin area and the bone harvested from the right Jaw , Pain is killing me !

    I have done bone grafting in the chin area where I had a bone loss , the bone have been harvested from the right jaw !
    The pain is killing me , and every thing is ok in the Area of the pain , no swelling ..etc …

    Is that normal Doctors ?

    How many days I should wait ?

    I did bone grafting 8 days ago , it is in the chin area and the bone harvested from the right Jaw , Pain is killing me

    Reply
    1. RamseyAminDDS Post author

      There is not much you can do unfortunately. I used to do this procedure a lot so I am very familiar with it.

      What you had as a block a bone graft taken from your chin. Nowadays I mostly use bone from a cadaver which can generate a wonderful amount bone as long as it’s done correctly and the right bone is selected.

      The nice thing about it is you don’t have to go digging in your chin to use bone elsewhere in your mouth and there is an endless supply.

      I would suggest having your doctor supply you with a chinstrap for the first three days but it appears to be too late. This is also called a jaw bra.

      Give it time and it will heal. Sorry you’re having so much trouble. Here’s a link on the block bone grafting that I do

      http://www.burbankdentalimplants.com/block-bone-graft-for-dental-implants-2015-update-ramsey-amin-dds-reviews/

      Reply
  126. Donna

    I just had a (synthetic) bone graft performed on an existing implant at #20 that is 1 year old. My implant was a little “loose” as the bone only formed well on my tongue side and was flush with the remaining sides. In an attempt to save my implant, the gum line was cut so the bone graft could be performed to build up the height around 2 sides. I had stitches for 10 days, used Peroident and was on Cipro (unable to tolerate Flagyl and had to cease using at 4 days) but continued Cipro. All looked great when stitches were taken out, no signs of infection or swelling but still sore with a tinge of blood when brushing every now and then. Within 7 days following, the gumline at the implant has receded to a ” v shape” at the base and I can see white and black at the base. Informed the perio who said all that can be done has been performed and I have to just wait and let it heal. Do I need a second opinion or is this a nice way of saying my implant just is not going to be saved? Is there anything I can do ??

    Reply
    1. RamseyAminDDS Post author

      hi Donna,

      It sounds like you have a very difficult situation. Your lacking bone on the outer wall which we called the buccal. This could’ve been thinned out over the year or your bone may have been inadequate from the beginning. The condition is commonly referred to as peri-implantitis. This particular post may help you understand better.

      It sounds like the implant may need to be replaced completely with significant bone rebuilding.

      Ramsey Amin DDS

      Reply
  127. Danielle Davis

    My bone graft literally started falling apart after 4 days. Its now day 5 sunday and I have a hole. Is this normal??? No stitches, no small white particles but a hole. I am not in any pain though.

    Reply
    1. RamseyAminDDS Post author

      I don’t think I have enough information to answer your question. Please give me a lot more detail. What type of graft and what technique was used?

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

      Reply
  128. Kathryn

    Had bone grafts 2 weeks ago everything seems fine but just noticed adjacent teeth have got white marks and surface is rough. I was unable to brush them for a few days after op but surely this couldn’t cause this. It’s like enamel has been scratched could this have been done when surgery took place? Can this be rectified? Please help thanks

    Reply
  129. Audrey

    Hello Dr Amin! Thank you for always sharing your expertise…I have been following your blog/vlogs for quite some time now.
    I am a 26 year old non-smoker, who has experienced quite some problems over my right front tooth(number 8). I had to have a root canal done 10 years ago, after an abscess formed over that tooth. This had to be repeated 5 years later when the root canal failed. This was also not successful and it was followed by an apicoectomy. This relieved me of my gum discomfort for a few months but this then returned. The oral surgeon then decided to open up the area once more and a second apioectomy was performed. Needless to say there was a lot of scar formation. I went to another oral surgeon who opted to remove the tooth on June 2013, and then allowed it to heal for a couple of months. There was still some discomfort at the time, up until a bone graft and titanium implant was placed in February 2014. All symptoms remitted and I was pain free. The implant was loaded with a crown in July 2014 and 10 days later I got a disomfort again. CT showed loss of bone over the titanium mplant that was hitting the gum. He reopened the area in August and using once again Bovine Bone he covered up the area that was deficient in bone. This did not help with my symptoms and the crown had to be removed in december. I was in Michigan in March and saw quite a few periodontists. I was told that there was lack of bone and that there was alos some tenderness on the adjacent tooth 7. The area was exposed and it showed that here was no bone covering the apex of the titanium implant. (There was no signs of infection and the titanium implant was firmly anchored). This was refilled using a combination of bovine and cadaver bone plus a plasma membrane. It has now been 5 weeks and I am still sore over the area, especially when I wear the flipper, even though this was shaved down to specifically not hit the titanium abutment. Part of the symptoms have remitted but the gum is still quite sore and i tend not to tolerate the flipper very well.When not wearing it there is still some tenderness. I am at a bit of a loss as I have spent quite a bit of money and many of the periodontists and implantologists seem to be baffled by my case. Would you be of the opinion that the soreness at the moment is within the norm, seeing how much work I have done in the past? Or would you believe that this might once again be failing and that at this point it is best to possibly consider removing the implant and restarting the whole process from scratch?

    Sending you my regards,

    Thank you

    Reply
    1. RamseyAminDDS Post author

      Hello Audrey,

      Thank you for your very kind words. I’m flattered to have a follower.

      If there were no signs of infections and the implant is firmly anchored, your bite may be the cause of all of this. Have your dentist check for what is called fremitus in your bite. Many dentists overlook this critical issue. Fremitus means your teeth removed when you bite down. You can test this yourself by holding your upper jaw teeth with your forefinger and thumb and bite up and down. If you feel your teeth move, you have fremitus which leads to overloading which ultimately leads to bone loss and implant failure…. Regardless of how well everything was done.

      Fortunately problems with your bite are easily remedied but this specific thing needs to be looked for. Many people have the outward sign of having slight recession and middle notches near the gum line who have fremitus. Fremitus leads to bone loss. Without seeing you in person, this is just a hypothesis but I see this fairly frequently when people get pain from a crown.

      About 2-4 weeks after even major dental surgery, all pain should be absent. Bone grafting on existing implant is difficult and unpredictable. This condition is called peri-implantitis. If the implant does not working, you should remove it and replace it

      Very Respectfully,

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

      Reply
      1. Audrey

        Thank you very much for the great prompt response! I shall definitely look into the notion of Fremitus as I suspect that I might indeed have it.
        Thank you once again for your help,

        Kindest regards,

        Audrey

        Reply
  130. maria

    hi, i just have block bone graft 2 days ago, and the swollen is getting worse, now i see is going to my eye and my nose is huge , and my upper lip is really big , im scared that my lip will stay like that because of the bone added, how long you think the swollen is gonna take ? thank u

    Reply
    1. RamseyAminDDS Post author

      Swelling can be greatly reduced by using an intravenous and or intramuscular steroid. Did you have one or both of these? Was the bone taken from your own body or taken from another human being?

      Surgical swelling does peak at approximately 48 hours so it is not uncommon to have swelling after such a major procedure….but it is about controlling swelling. I do a lot of these and there are techniques to reduce swelling such as L PRF but regardless swelling is to be expected.

      This post on block bone grafting may help you as it is more specific than this particular post you are on.

      Taking an NSAID medications such as ibuprofen may help but it is just going to have to take its course. Make sure you stay on an antibiotic and see your dentist for multiple follow-ups

      Respectfully,

      Dr. Amin

      Reply
  131. Jyotiranjan Parida

    I had a dental implant surgery in which two implants were placed in my upper jaw, they also put a PRF membrane containing my own blood, now after five days having the surgery I still feel something is there beneath my upper lip inside my jaw ,although the swelling is gone already.
    Is it normal and is it due to the PRF placed?

    Reply
    1. RamseyAminDDS Post author

      PRF can be used in a number of different ways. It may have been placed under the “flap” of the surgery. Give it some time for all swelling to subside. If it is a PRF membrane placed underneath the flap, it may need 2 weeks to dissolve. I’m sure it will be fine.

      Here’s some more information about PRF.

      Good luck

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

      Reply
  132. Harrison Sturdevant

    4 years ago I was hit with a baseball and suffered the loss of my front two teeth. One was able to be salvaged and the other one was not. I am now 17 years old and undergoing the process of recieving an implant. About two weeks ago I recieved a bone graft using titanium mesh to build width for an implant down the road. A few days went by during the healing process and then I hit an obstacle-an infection. It was taken care of immediately. Now im on the road to recovery with almost all of my stitches and sutures still intact. I have noticed my gums above and around my missing tooth have been drastically receding. Around two hours ago I noticed a large portion of the titanium mesh is showing through my gums. I have no pain and no blood. I thought that would be expected for such a large gap in my gums. Sorry for the length of this question. I’m just wondering if this is normal or if it should be taken cafe of immediately. Please respond promptly. Thanks

    Reply
    1. RamseyAminDDS Post author

      Here is an article on titanium mesh reconstruction bone grafting.

      Ideally, the titanium mesh never gets exposed. Once it does, the volume of the bone graft is definitely compromised. We call this dehiscence as the true medical term. Most likely this portion of the titanium mesh and bone graft is going to need to be removed. This cannot be resutured again.

      A titanium mesh bone graft is a very difficult bone graft and should be handled by an expert implant dentist. You have a huge role on the healing. We cannot let any type of temporary touch the graft at all. You should not wear a temporary for the first week or 10 days for this type of bone graft. I’m hoping you not a smoker or use marijuana.

      Extended treatment with antibiotics, cleaning out the dead bone and possibly treatment with L PRF may help you. You will likely need a revision bone graft. You need to see your dentist ASAP

      Also consider delaying your implant until you’re a bit older. 17 years of age you may not be done growing yet.

      Good luck,

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

      Reply
  133. Sharon Muyco

    Two weeks ago I was eating something hard and my tooth (the eye tooth next to my right large tooth in front)fell out. I immediately had an extraction and a bone graft prep for an implant. I had the dentist check me two times that week to make sure everything was ok because some if the white material (gauzy) was flaking out. He said I was fine. I was worried because I can’t take antibiotics. I asked him if I should have Periodent (Chlorohexadine) to prevent infection. He said it was not necessary.Then I didn’t see him for a week and went in to get checked. My gum line and my area around the incision was swollen and it hurt. He checked it and said that it was infected and it was not healing well. He THEN put me on chlorahexidne three times a day and sent me home for another week. I have been washing my mouth out with it for almost two days now and there is still blood and pus and very sore. What should I do?

    Reply
    1. RamseyAminDDS Post author

      You need the be on an antibiotic. Surely you must be able to take some type or you risk failure and other complications.
      Why can you take them??

      Reply
  134. Gail

    Moderate bone lose around one area of #8 tooth, Bone Graft on the area without extraction. Since sutures were removed where the gums are lifted I’ve experienced sensitivity to cold, is this normal and for how long?

    Reply
  135. Lourdes

    After the bone graft, there was some kind of “band aid” place over the surgical section. How long should that stay in, and does it move by itself even though you are been very careful not to disturbed it?

    Reply
    1. RamseyAminDDS Post author

      Hi Lourdes,

      You may have had what is called Perio pack placed around your bone grafted area. It often looks like a bubblegum colored putty that is placed on your gum. I use this product very infrequently. Tends to crumble and break off within just a few days. Most likely your dental implant dentist will take it off within 1 week.

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

      Reply
  136. Breanna

    Hello,
    I had surgery to remove an abscess followed by a bone graft.
    When can I expect the swelling to go down? I have no pain but my face is still visibly disproportionate.

    Reply
    1. RamseyAminDDS Post author

      Swelling is variable in every person. It is highly dependent on the degree of difficulty of the bone graft, your healing ability and the skill of your dental implant dentist.

      Average swelling is going to last somewhere between 1-7 days. This can be greatly reduced by using intravenous/intramuscular steroids that would be given to by your dentist. I also find that when I use your own blood concentrates such as L PRF and PRP that most patients have literally no swelling.

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

      Reply
  137. M.W. Willis

    I want to proceed with having upper /lower dental implants but having my calcium intravenously I want to wait on that my gums may properly heal. Are there any risk factors in my decision?

    Reply
  138. ben willitts

    Over a year ago a bone graft was used to build up the area damaged by an infection. The dentist wanted to do a second graft which I refused since I didn’t know how many $350 grafts would be required before an implant could be placed. Recently another dentist showed an xray of the graft setting vertically and protruding into my sinus cavity. How could the graft move so drastically or was it improperly placed.

    Reply
    1. RamseyAminDDS Post author

      Protruding into the sinus is a good thing if that was the intention. That would be a sinus bone graft. Some areas (especially uppers) need secondary grafting. An experienced dental implant dentist will tell you that before you ever start.
      There is no way for me to know if it was placed correctly.

      Is it an upper tooth??

      Reply
  139. Raj Kumar

    Dear Admin,
    I had a surgery for “unicystic ameloblastoma of the right mandible” they had given me the treatment of “Resection and Vascular reconstruction with fibula graft” in the month of November 3rd 2014.Now I want to have implants how much time it takes to settle the graft in the jaw.can I go through the fixed implants now.my doctor said that it takes minimum 1year for bone grafting to settle and he suggested for temporary removable implants for 6 months.My question is how many months it takes for the bone to settle.And also doctor said that the upper teeth may come down slowly if don’t take the temporary implants does its true pls clarify my doubts.

    Thanks& Regards,
    Raj Kumar.

    Reply
    1. RamseyAminDDS Post author

      A unicystic ameloblastoma of the mandible is an aggressive tumor. You had to be reconstructed with a part of your leg bone graft into your mouth. That type of bone is different than our typical upper or lower jaw bone.

      Because of your unique situation, the standard timeframes should be modified. I would suggest waiting longer rather than trying to move to quickly. If your lower teeth are not replaced with some sort of permanent or temporary teeth, the upper teeth will drift downward. This is called supra-eruption and will only complicate things. I hope you get well soon.

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

      Reply
  140. Carolyn niess

    I had a failed implant due to implant placed in a one step process and found out dead bone caused it to fail. I had an oral surgeon remove the implant and do a bone graft in the lower left side #19. I had the failed implant done on May 5 and the removal of it PLUS the bone graft done on May 18. I was checked by the oral surgeon on day 3 post surgery. I am still having to take 2 Advil every 6 hr or so for pain . Cadaver bone plus stem cells were used in my bone graft. . Is this normal?

    Reply
    1. RamseyAminDDS Post author

      Hello Carolyn,

      Pain levels can be variable in patients. Depending on the magnitude of the bone graft, skill of your surgeon and your healing capabilities it is possible for you to still have pain 20 days later. I would say this is more uncommon as most patients that have even very large block grafts done by me will be okay by the fifth day.

      Make sure you see your dentist for weekly follow-ups until the pain is gone. I would assume that you are infected and may require a second round of antibiotics or switch to a different family of antibiotics. This post about antibiotics may help you understand.

      The one-step process you described is called an immediate implant. Of course I don’t know why your particular implant failed, but one-step-immediate implants are extremely successful when this is indicated. I have placed several thousand immediate implants with the same degree of success as implants that are delayed by a few months.

      I hope everything works out for you. Keep me posted.

      Ramsey Amin DDS

      Reply
  141. Michael Russo

    On march 23rd 2015 my family dentist extracted my tooth #7 and used human bone grafting material to build up my natural bone for insertion of an implant 6 months later. The tooth had been infected for quite some time and the gum above the tooth developed a fistula which had been draining. I have noticed bone graft fragments coming thru the fistula. Not many, about 1 a week. I’m concerned about the fistula healing. Is this normal and how long can I expect this to continue? Thank you, Mike.

    Reply
  142. Irma

    Hi, I had an implant done about 7 months ago. My doctor extracted the tooth did a ridge preservation on the same day of extraction. The implant was place 4 months later. I ended up with an indented gum right where the implant is. My question to you is why do you think this happened? And would a bone graft to the top of the implant lift my gum again so that the implant is not as obvious?

    Reply
    1. RamseyAminDDS Post author

      Hi Irma,

      There are so many reasons. I assume this is a front tooth. The bone grafting technique for keeping the bone from indenting is different than a normal site. The bone type has to be most non dissolvable. This is most critical if you have genetically thin guns and bone. Sometimes it can be corrected after the fact with a graft. These are HIGHLY technical grafts that do not always work.

      Take care.

      Reply
  143. Bev

    I had my bone graft done April 27,2015 I was wondering how long will you be in pain. The pain has subsided but is almost like a dull headache in that area. It was mixed with cow bone it is my lower jaw 2nd molar. I take ibprofine usually one is only needed. Thank you very much for your time…..

    Reply
    1. RamseyAminDDS Post author

      Pain, if any is usually limited to 2-10 days for routine procedures. Was it complex? Do you have anything in your medical history that would slow down your healing such as smoking, heavy alcohol, diabetes, autoimmune disease, etc??

      The type of bone is usually not a factor for pain. Your own bone would be the most painful.

      Reply
      1. Elizabeth

        I’m so grateful for the opportunity to reach out to you with my question.

        12 days ago, I had #8 extracted after an infection. It was the site of a 20 year-old root canal followed by an apico that further preserved the tooth for 8 years. A particulate bone graft was needed to build bone before an implant can be placed down the road.

        The flipper created for me had an impression of the wrong tooth, so I could not wear it for the 24 hours following the surgery as recommended. Since the second impression was taken immediately after the procedure when there was initial swelling, the new flipper now fits loosely – but I wear it as instructed. I have called and visited my dentist’s office for pain when wearing the flipper, but have been told twice that there is no immediate concern since I have pink gums that appear to have healed well.

        12 days later, with sutures out, I am feeling throbbing pain and need to take 800mg of ibuprofen every 6 hours for relief. If I fall behind on dosage, the pain is intolerable. The two adjacent teeth are sensitive and there is a salty-tasting, clear, but foul smelling fluid draining from the small hole at the site each morning and a few times a day. The oral surgeon tells me that pain and a small amount of drainage is to be expected. The dentist working with him treated me as well and he thinks the discomfort might be caused by the flipper. He scheduled an adjustment and a silicone liner for comfort in 18 days – a full month after the procedure. That seems like a long time to wait. But he encouraged me to be patient with healing. So, I continue to use saltwater gargles and tea bag compresses. I also rinse with mouthwash.

        Tonight, the pain is keeping me awake even with the 800mg taken 2 hours ago. A new symptom is that my inner nostrils now sting like I’ve just inhaled water from the ocean. The one nostril above the site also feels congested. The other bled a very small amount after a gentle blow.

        It seems to be getting worse before getting better.

        Should I still feel this much discomfort in so many forms?

        Reply
        1. RamseyAminDDS Post author

          It sounds like you may have a low-grade chronic infection. I would do another course of antibiotics. I would probably switch to a different antibiotic or add another one. Please search my site for the post on antibiotics. It might help you.

          Reply
  144. Stacey R

    Hi Dr. Amin,
    Last July, I had upper and lower jaw surgery to correct sleep apnea. The good news is my sleep apnea is cured, but I had to go back in two weeks ago for bone grafting because my upper jaw apparently didn’t heal properly and was mobile. I was told that I had 1 mm on the left side and 3 mm on the right side that needed grafting. I have stayed on a liquid diet and wear elastics overnight. I was wondering how long this type of grafting takes to heal. I can tell that my upper jaw is still mobile–is this normal? Does it take a while for the bone to solidify? I think a combination of synthetic and bovine and/or cadaver bone was used.

    Reply
    1. RamseyAminDDS Post author

      Hi Stacey,

      It doesn’t sound like you had one of the more standard types of bone grafts. It sounds like you had mandibular/maxillary advancement surgery called orthognathic surgery. The real term is called a LeFort osteotomy and bilateral sagittal split osteotomy. The jaw is cut and moved forward in an effort to open the airway and reduce sleep apnea. Typically either the jaws wired shut or screws and bone plates are placed to keep the bone from moving while the graft is healing.

      If there is any movement in any type of bone graft anywhere in the body it will not heal. It creates a fibrous union rather than strong bone healing. You need to see your surgeon ASAP. This could become badly infected requiring you to return back to the operating room to resolve.

      Respectfully,

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

      Reply
  145. Donnetta Lee

    Dr. Amin: I have written before but think I must have “sent” my question incorrectly. This is my second try!

    My dentist performed a bone graft lower right side–I believe area #30. Immediately infected. Rounds of antibiotics. Failed and had to be redone. Had to have antibiotic injections with the second graft. At the same time, my endodontist retreated a root canal in tooth directly behind the graft. Five months later, I am still healing–but in constant pain. Both dentist and endodontist say it is tmj difficulties and muscle pain. Endodontist says a ligament around the tooth is probably inflamed due to bruxism and now I having a mouth guard made. I am now terrified to have anything else done at all. I stay “sick” feeling, tired, and my face, teeth on that side burn and ache continuously. Luckily, I can sleep at night. Dentist wants to put in implant but now I am too scared. He agreed we could wait until August (9 months following graft), but wasn’t happy about it. My question is: what happens if I just give up on this thing? Maybe simply get a partial plate. Both dentist and endodontist say the work looks good. Well, it feels horrible. Can’t tell if the pain is from surgery area or the root canal or both. Wish I had never done anything! Thanks for any thoughts. Donnetta

    Reply
    1. RamseyAminDDS Post author

      The undifferentiated connective tissue disease worries me.

      Your bone is a type of tissue. Have you had extensive medical testing to make sure that your bone will heal properly after dental implants? Typically blood work and a history and physical is done when a patient has medical issues that are unique and treatment may be substantial and complicated. I have encountered patients that had all types of syndromes, deficiencies and medical ailments that we decided not to do treatment or to alter the way that we did our treatment. You should have a full medical workup. I am assuming you have not taken intravenous bisphosphonates or bisphosphonates-type medications such as prolia injections. These can cause osteonecrosis of the jaw and/or delay healing. You should also be tested for vitamin D deficiency and any problem of bone metabolism.

      Most patients who undergo even advanced grafting and dental implant procedures in my office heal very well and do not have major issues. In fact they’re usually quite surprised how simple all of this is.

      good luck…

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

      Reply
  146. Tiffani

    Hi Dr. Amin,

    I had a socket bone graft done on March 6th after a tooth extraction. They harvested a bit of bone from my lower jaw. My lower jaw remained swollen for awhile and I couldn’t open my mouth. That faded but I had a piece of lose gum with some pain still. They told me this was normal as some bone was jabbing me from where they opened it up. They reopened the site to clean it up and wash it out. I’m now with stitches and on antibiotics. Is this normal? Also, I have a red, semi-inflamed bump on the bone graft site pressing against the last tooth. When I floss it bleeds… Is this ok? I’m a bit anxious.

    Thanks,
    Tiffani

    Reply
  147. Teresa Clark

    Hi Dr. Amin, I was told I have to a full mouth, upper, bone graft. I was wondering if I would have to wait for it heal before I can get implants?
    I do take Fosamax, I have been taking it for one year now.
    My dentist wants to do a sinus lift first to see if I can wear my upper dentures first. If not then he wants me to have a upper bone graft.
    I was wondering if I do the bone graft can I get implants or am I going to have to wear dentures forever?

    Reply
    1. Ramsey Amin DDS

      Hello Teresa,

      Not sure I totally understand your question.

      There is no reason to have bone grafting done if you’re not currently having dental implants. A sinus lift bone graft is a very predictable type of bone graft to rebuild bone for your upper back teeth.

      Fosamax is an oral medication called a bisphosphonates which can cause a condition called osteonecrosis of the jaw. Usually only taking it for 1 year doesn’t carry a huge risk but you should still be tested for risk factors if you are undergoing a major reconstruction with dental implants and bone grafting.

      I’m not sure if I completely answer your question because I didn’t really understand it.

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

      sinus lift basics

      Very Respectfully,

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

      Reply
  148. Novena King

    I straightened my teeth with Invisalign, and now have 2 upper premolars cracked at the root.
    The dentist put a filling in both, to give me time, as I did not want to be without teeth at the moment as I am job hunting.

    One tooth is now tender to touch. What is the likely hood the tooth can be removed and an implant/bone graft done at the same time, or will I need to have the tooth pulled then wait for it to heal.

    Your opinion will be appreciated.

    Reply
    1. Ramsey Amin DDS

      What you are asking is to do any immediate dental implant with an immediate temporary. This depends on your unique anatomy, the skill and experience of your dental implant dentist, your classification of bite and a number of other things. I’m willing to bet the upper premolars are tooth numbers 5 and 12 in the US classification numbering system.

      In order to possibly assess the bone quality, and bone volume a 3-D CBCT scan will need to be done to evaluate how much bone you have and how dense that bone is. This procedure is difficult but is not totally unique. Expect to need a bone graft to fill in the void between the dental implant and the extraction site. Attached are some web links to help you.

      The “Void” Bone Graft for Immediate Single Implants – American Board Diplomate Explains

      3-D scan basics

      immediate placement

      Very Respectfully,

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

      Reply
  149. Rachel

    Hi,

    First of all I think you are very kind to answer all these questions from people who are not your patients. From reading all of the above you have obviously been able to give a great deal of advice & comfort.

    I had a sinus lift & bone graft 4 weeks ago. The swelling has only just gone & I can feel where the mass of bone has increased under the area of my upper lip. I am aware that I needed extra bone height & width for my planned implants. However I am left looking rather different (not in a good way) & was assured my appearance should not be altered.

    I have been told that the grafted bone can reduce by up to 33% over the coming months. Is this the case? I do not want to be left looking the way I do now.

    Regards.

    Reply
    1. Ramsey Amin DDS

      Hello Rachel,

      Thank you for your very kind words. I enjoy answering all these questions. 😉

      My guess is you still have some type of swelling that remains because a sinus lift bone graft would not change your external appearance because it is a bone graft that is done within a cavern of the skull. It is not done on the outside. Are you sure that you did not have a sinus bone graft plus an additional graft for the outer side of the bone? Even if you did have another bone graft, it is extremely unlikely that sure out toward appearance would change unless you have a very bony face and thin skin and had a massive bone graft done.

      I performed this procedure routinely and will rarely see any swelling at all but my surgical technique and patient management techniques are very different.

      Graft shrinkage is primarily dependent on what type of bone was used for the graft. Believe it or not, the bone shrinks the most is your own bone as opposed to cadaver, cow or synthetic.

      3-D view of the inside of sinus in real time
      sinus expansion

      I hope this helps.

      Respectfully,

      Ramsey Amin DDS

      Reply
  150. katica

    Dear Dr. Ramsey,

    Today I underwent bone grafting. A piece of food managed to enter my gums on my bottom front teeth and as a result became infected. My dentist urged me to undergo oral surgery and so I booked it immediately. However, is it possible that while he was removing the infection under my gums and on my jaw bone he moved my teeth? I seem to notice them slighly crooked?

    Thank you for your kind help in advance,

    Katica

    Reply
    1. Ramsey Amin DDS

      Not likley… Teeth do not move very easily. You are probably looking at your teeth more critically than you were before the procedure. Sometimes the pressure of removing one tooth, bruises the tooth right next to it. It should recover

      If your teeth moved, your bite would feel different than your teeth would not mesh together normally.

      Ramsey Amin DDS

      Reply
  151. zak ivanov

    Hi
    I had a failed 8mm implant 6 month after its placement on the lower left back side extracted and a bone graft done on the spot in march 2014.
    How much this area has been being compromised to successfully accept and hold another implant after the grafting procedure?
    What are the risks and would you recommend a second attempt?
    How long can I wait before putting another implant?
    Your advice?
    Thanks
    Zak

    Reply
    1. Ramsey Amin DDS

      An 8 mm dental implant is considered to be very short. It is only used when it is not safe to place a longer implant because of a bone depression or proximity to your main nerve. If a short implant is used, it is best for it to be of a large diameter. Implants that are 10 mm and shorter have a higher failure rate.

      Without seen you it is impossible to answer your question. A lot of this depends on the surgical ability and experience of your dental implant dentist. Your case sounds like a procedure for a very advanced and experienced implant surgeon.

      A second dental implant is very likely to work. My guess is you will need some type of bone graft. Go slow. Do not try to do too many things at once. Definitely have a 3-D scan done before attempting placement of a second implant.

      Links of interest:
      Video – Short, Narrow Dental Implants – Do They Work?
      Short Dental Implants – A Unique Solution to Avoid Nerve Damage

      Very respectfully,

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

      Reply
  152. Tracey

    Hello, I had an unexpected bone graft almost 2 weeks age due to my lower jaw being too soft for the implant (surgeon attempted & the bone split or cracked or fell apart). I still have quite a bit of pain in the area of the graft: I thought I would be feeling much better this far out. How much time is “typical” for the pain to recede?
    Thank you,
    Tracey

    Reply
    1. Ramsey Amin DDS

      Hello Tracy,

      It is difficult to answer your question because I have not treated you and do not know the details of your situation. In my dental implant office I reduce postoperative pain by many techniques included but not limited to intravenous sedation, intraoperative anti-inflammatories given intravenously, platelet rich fibrin, analgesic effects of Marcaine, nonsteroidal anti-inflammatories such as Toradol, antibiotics and of course good surgical sterile technique and a patient that does not have medical issues.

      Some surgeries are just far more difficult than others. I hope you get well soon.

      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?
      3 Myths About Tooth Implants -Pain, Expense and Time – Burbank Dentist Explains

      Very respectfully,

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

      Reply
      1. Tracey

        Dr. Amin, Thank you for your response. I am vastly improved this week so must have just had to pass a hurdle.
        I appreciate your attention to questions online!
        Tracey

        Reply
  153. Kristina

    I had a tooth extraction yesterday. My dentist did the bone graph and membrane. Is it normal for the membrane to be coming out from between the stitches?

    Reply
  154. Nader

    Hello Dr Amin,
    I’m 52 years old male & lost all my teeth 15 years ago. Since I’ve been injured in one of London’s terrorist bombing & have severe chronic back pain, I have to take daily medications of 210 ml of Diamorphine & 70ml of oral Methadone to relieve the pain. I also smoke 20 cigarettes a day.
    I’ve been told if I want to have 4 on 6 implant I don’t need a bone graft but as I like to have the ” Fixed permanent Bridge ” I need to have Bone graft for upper & lower jaw before hand.
    I can cut the smoking down to half but not my medications. would smoking 10 cigarette a day & my medical conditions effect the success rate of healing & the treatment of both ?
    What are my chances? Should I take a chance & go for bone graft & see what the outcome is or would you say there would be no point in doing any of it in my situation.
    I really need your advice & appreciate your time in advance.

    Reply
    1. Ramsey Amin DDS

      Hello Nadar,

      So sorry to hear about your situation…. Brighter days are ahead 😉

      The narcotics that you take is not the issue. Smoking 10 cigarettes or more per day is considered heavy smoking and will definitely impair the ability of dental implants and bone to heal. It drops your success rate by 12-15% especially in the upper jaw.

      Strongly consider stopping smoking. I have had many patients. By using medications such as Chantix and many other patients have successfully used hypnosis. The last thing you need is failure of a complex dental implant procedure and to lose time and a significant amount of money.

      I would suggest a Prettau dental implant bridge on 6 implants. This will provide you long-term stability and support. The most distal implants can be placed at a tilt and possibly avoid the need for bone grafting.

      Here is a link for some more information:
      Prettau Dental Implant Full Mouth Bridge

      Very respectfully,

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

      Reply
      1. Nader

        Hello Dr. Amin,
        Thank you very much for your advice & the link provided.
        I wished I lived in United State and could come to you for my implants, but since I live in London, UK, I was wondering if you have a branch over here? If not, do you know or could you recommend any Dentist (Oral Implantologist) in UK who does similar practice & technics such as yours or at least are trust worthy?
        As I was nearly conned for £20000 recently and funny enough they are practicing on famous ” Harley Street ” which as I am sure you know top Doctors & Dentists have their practice there, but many people have been conned or had failed surgeries all over UK and you don’t know if they are or the advice they are giving is genuine.
        Also How much would having ” Prettau Dental Implant Full Mouth Bridge ” cost?
        Again I very much appreciate your time & expertise.
        God Bless.
        Nader.

        Reply
        1. Ramsey Amin DDS

          hi Nader,

          I don’t know someone in London. The prettau runs about $28 -$35,000 as of 2015.
          Good luck!

          Dr. Amin

          Reply
  155. brittani

    Hello, so I had a bone graft done on my lower left molar to try and save the tooth about three weeks ago. I’ve had some of the material fall out somewhat often. Today it was about twelve small granules which was the most at one time. Usually it’s just one or two here, maybe three or four there. Every day to every couple days maybe for the past two weeks. Also there seems to be a lot of gum recession and it just seems somewhat gappy or caved in. There’s just a space there that wasn’t before. I’ve heard material falling out, and gum recession can be normal..But this just seemed like a bit much. Should I be worried it’s failing?

    Reply
  156. Hong Dao

    I had a implant with bone grafting 2 months ago. The recovery was good with no infection. Somehow I still have a bump right where the implant is. The swelling has not gone down inspite of the fact, it was done 2 months ago. Is this normal? I feel one side of my face is heavier and not balanced. Even when i talk, it feels different.

    Thank you so much.
    Hong

    Reply
    1. Ramsey Amin DDS

      Hi Hong,

      It is possible that what you are feeling is the increased volume of the bone graft which is the intended result. It may feel bigger to you because you got used to a large bone depression.
      It should not change her facial appearance at all unless you had a massive, full arch titanium mesh reconstruction bone graft…. But I doubt you have had grafting to that degree as it is not as common.

      Did you have BMP from an outside source? That can cause major swelling… I’m not a big fan of BMP that is not made from your own bloodstream. BMP is the abbreviation for bone morphogenic protein.

      I use your own blood as nature’s Band-Aid. Blood concentrate made from your own blood such as PRP/PRF/PDGF contained natural bone morphogenic protein found in your own blood. It is a major enhancement to healing if done properly.

      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?

      Respectfully,

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

      Reply
  157. Suzi

    Thank you so much for your quick reply, Dr. Amin! How I wish that I could have done my surgery with you ! Now I know what you mean PRF/PRP/PDGF in your link….

    Reply
  158. Suzi

    Hi Dr. Amin,

    I had a bone graft done from my lower chin area at almost one year ago. My dentist told me that she need some excessive bones while she was doing the operation. The grafting was done on the upper right area and it seems healing ok. However my lower china area is still painful after such a long time and some of the teeth (root) in that area are very sensitive (better not touch it). Is there something wrong ? She did take a x-ray around the area and it looks ok. What else can I do (or what kind of doctors in other fields should I see) to check what is wrong with my lower left jaw/chin area ? Thank you very much for your time – I am so glad to find this link and really appreciate that you provide all these help online !!

    Reply
    1. Ramsey Amin DDS

      Hello Suzi,

      It sounds like you had a block bone graft done from what we call the symphysis. That is your chin. This is an excellent area to harvest a lot of bone.

      In order to take bone from this area, the bone cut must be several millimeters below your lower front teeth. It is possible that one or more of your lower front teeth may be dead. Obviously this is not something your dentist intended to do, but sometimes our nerves have different anatomy. It is a risk of the procedure.

      I would suggest you see an endodontist which is a specialist in root canals. These teeth should be tested for vitality. This will allow you to determine whether or not you have a dead tooth present. If so, a root canal may be needed which would be very simple and likely alleviate all of your pain. Hopefully it is just that simple! I would also suggest that you have a 3-D scan done of the area to really evaluate it properly.

      In my own technique of block grafting, I soak the bone in the harvested area in your own blood concentrate call PRF/PRP/PDGF that is manufactured from about 20 cc of your own blood. Also there are times where using a bone block from another human being can be more beneficial than using bone from our own body. Again I am assuming you had a block bone graft with fixation screws. I performed this procedure very regularly for the last 15 years. Block bone grafts are excellent. Over the last 5 years I have transitioned more towards using block bone taken from a cadaver rather than the patient themselves.

      Here’s some information:
      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?
      Cone Beam 3D Scan X-ray
      What is a “Block Bone Graft” Associated with Dental Implants? — Video

      Good luck,

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

      Reply
  159. Drusilla Clingan

    Hi doc
    I just had oral surgery on the 5th on tooth 1,32,7, and 10. I got bone grafts done on 7 and 10. 2 days later the sutures plus the paper on #10 came out i know some of the shards are suppose to come out but now there is a hole where the graft should be …should i be worried im concerned that all the bone graft has come out and now im gonna get a dry socket it has been very painful the past 2 days…???

    Reply
  160. Carol Williams

    Is it common practice to take an X-ray immediately prior to doing a bone graft? My periodontist used an X-ray from 7 months before and the procedure went very badly. He said that during those seven months I had developed an infection as well as a broken tooth under a bridge but that he had no way to know that and will use an X-ray up to one year old. I spent nearly a year without teeth on one side.

    Reply
    1. Ramsey Amin DDS

      Hello Carol,

      I would not say that it is common to take an x-ray immediately prior. Generally speaking an x-ray that is 6 months to 1 year old is sufficient. Generally speaking if there is a change in symptoms or status, a new x-ray will be taken. It is always best to use as little radiation as reasonably possible. Sometimes there are surprises and infections in the bone are far worse than they appeared on standard x-ray.

      3-D scan is way more accurate at the determining the extent of bone deficiencies and bone infections.

      Here’s some information:
      Cone Beam 3D Scan X-ray
      Digital X-rays During the Placement of Dental Implants

      Good luck,

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

      Reply
  161. Hossam Nabil

    Hello,
    I am 32 years old and I suffer no pressure from disease or diabetes or any other disease But I lost a front tooth upper jaw and I was wondering that the bone grafts and dental implants can be done simultaneously ? And if this was possible, what are the conditions
    thank you

    Reply
    1. Ramsey Amin DDS

      Hi Hossam,

      In some cases bone grafting and dental implant can be done simultaneously and in fact it may even be beneficial to do so. Some cases need to be done in stages. This is determined on a case by case basis and I would definitely recommend a 3-D scan and virtual implant planning in order to know this before you even start.
      Using your own blood special concentrates like PRF/PDGF/PRP can be made to enhance your healing and speed up the whole process. I find this to be extremely beneficial and have been doing this for 12-13 years now. Sometimes actually grow too much bone!

      The conditions for choosing simultaneous bone grafting and dental implant placement are multifactorial. The final cosmetic outcome is a major issue in require that each staged be done very carefully and over a long period of time especially this is an upper front tooth. Be sure to be in the hands of somebody very skilled and capable with many years of experience.
      Good luck to you!

      These web links may help:
      Burbank Implant Dentist Explains: Immediate Front Tooth Replacement with Bone Expansion Grafting
      PRF INFO
      guided dental implant surgery

      Very Respectfully,

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

      Reply
  162. Hossam Nabil

    Hello,
    I am 32 years old and I suffer no pressure from disease or diabetes or any other disease
    But I lost a front tooth upper jaw and I was wondering that
    the bone grafts and dental implants can be done simultaneously ?
    And if this was possible, what are the conditions
    thank you

    Reply
    1. Ramsey Amin DDS

      Hi Hossam,

      In some cases bone grafting and dental implant can be done simultaneously and in fact it may even be beneficial to do so. Some cases need to be done in stages. This is determined on a case by case basis and I would definitely recommend a 3-D scan and virtual implant planning in order to know this before you even start.
      Using your own blood special concentrates like PRF/PDGF/PRP can be made to enhance your healing and speed up the whole process. I find this to be extremely beneficial and have been doing this for 12-13 years now. Sometimes actually grow too much bone!

      The conditions for choosing simultaneous bone grafting and dental implant placement are multifactorial. The final cosmetic outcome is a major issue in require that each staged be done very carefully and over a long period of time especially this is an upper front tooth. Be sure to be in the hands of somebody very skilled and capable with many years of experience.
      Good luck to you!

      These web links may help:
      Burbank Implant Dentist Explains: Immediate Front Tooth Replacement with Bone Expansion Grafting
      PRF INFO
      guided dental implant surgery

      Very Respectfully,

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

      Reply
  163. jamie

    My dentist put two holes in my upper gum left side rear tooth and put some sort of crushed bone in there to build up the gum around the implant. Have you heard of this before

    Reply
    1. Ramsey Amin DDS

      Hello Jaime,

      It sounds like you had a tunnel technique done. This can be done through a small incision or a pinhole. The purpose of doing this as not to disturb the gum around an existing implant. I am assuming that you have a problem with your dental implant which is likely peri-implantitis.

      Using platelet rich fibrin (PRF) will help the extraction tunnel tremendously. I use this routinely for gum grafting and/or bone grafting with or without a tunnel incision/dissection.

      Here is an article I wrote a few years back:
      Tunnel Bone Grafting for Dental Implants

      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?

      What is Peri-implantitis and What Do I Do About It? – Bone Loss Around Dental Implants ~Burbank Dentist, Ramsey Amin Reviews

      Very Respectfully,

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

      Reply
  164. Kiairi

    hello doctor,
    I had gotten a bone graft put in after i had a failed coot canal tooth taken out. I was wondering. there are pieces of the bone graft coming off sometimes. I am still kind of confused on what material the graft is made out of, are the pieces actual bone? if so, would they have taken what was broken from my old tooth or would it have been someone else’s?

    thank you
    Kairi

    Reply
    1. Ramsey Amin DDS

      Hello Kiairi,

      You should be fully aware of what kind of bone was placed into your jaw. There are different risks benefits and alternatives to your own bone, cadaver bone, bone from an animal such as a cow and synthetic bone. These are long and extensive conversations that I have with each patient before we start treatment.

      This post about bone exposure and membranes should help you decipher things a bit.

      Also using platelet rich fibrin-PRF helps to contain bone graft materials and supercharged are healing. It is like natures Band-Aid!

      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?

      What Is A Membrane? Do I Need One For My Implant Bone Graft? My Membrane Fell Out/Sticking Out And Exposed

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

      Very Respectfully,

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

      Reply
  165. Kiairi

    hello doctor,
    I had gotten a bone graft put in after i had a failed coot canal tooth taken out. I was wondering. there are pieces of the bone graft coming off sometimes. I am still kind of confused on what material the graft is made out of, are the pieces actual bone? if so, would they have taken what was broken from my old tooth or would it have been someone elses?

    thank you
    Kairi

    Reply
  166. Kimberly

    Hi Dr. Amin,
    I got a bone graft one week ago on my upper left molar. I’m still eating soft foods but when can I transition back to regular foods i.e. spicy and/or hard meals? And when can I use regular mouthwash again?

    Reply
    1. Ramsey Amin DDS

      Hi Kimberly,

      Your dentist can best advise you on this but typically 1-2 weeks is about average. In general you do not want to chew on a bone grafted area for 4-6 months. This also depends on whether you had a small basics socket bone graft or something more substantial like an onlay block bone graft or lateral window sinus graft.

      Regular mouthwash can be used to any time… But typically your placed on a special mouth rinse called chlorhexidine.

      Related links for you:
      Sinus Lift Bone Graft
      What Is A Membrane? Do I Need One For My Implant Bone Graft? My Membrane Fell Out/Sticking Out And Exposed

      Good luck,

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

      Reply
  167. Kimberly

    Hello Dr. Amin,

    I got a bone graft on my left upper molar one week ago and I was wondering when I could begin eating normally again. I’ve been sticking with soft foods, but I’m getting varying opinions on when I resume eating spicy and/or hard foods? Is 2 weeks after the surgery standard?

    Also, when can I use regular mouth wash again?

    Thank you!
    Kimberly

    Reply
    1. Ramsey Amin DDS

      Hi Kimberly,

      Your dentist can best advise you on this but typically 1-2 weeks is about average. In general you do not want to chew on a bone grafted area for 4-6 months. This also depends on whether you had a small basics socket bone graft or something more substantial like an onlay block bone graft or lateral window sinus graft.

      Regular mouthwash can be used to any time… But typically your placed on a special mouth rinse called chlorhexidine.

      Related links for you:
      Sinus Lift Bone Graft
      What Is A Membrane? Do I Need One For My Implant Bone Graft? My Membrane Fell Out/Sticking Out And Exposed

      Good luck,

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

      Reply
  168. DeeDee

    About 2 years ago I had my #9 tooth removed. Upon removal, it was discovered that an infection had eaten away at the root of the tooth and also the bone. It was so bad that if he blew air on the extracted site, my cheeks on both side puffed out.
    My dentist placed graft material, closed me with plan for implant in 6 months. 6 months later he placed the implant. 4-5 months later, the crown was placed. A month later it failed.
    The implant was removed and the area cleaned and more bone placed. I met with his last week (which is 6-7 mths later) and while the bone is much improved his opinion is that he has the minimum for the smallest implant but he is advising against this as he believes it will fail again. He is suggesting a bridge.
    I have my reservations, but I was resigned to doing this, because I hate the idea of destroying 2 perfectly health teeth. I am conflicted. Family members are suggesting a second opinion before making such an irreversible decision.
    Is it impossible to grow more bone? Is the gold standard for only 2 attempts at regrowing bone with the graft material?
    Any advice is helpful. Thank you

    Reply
    1. Ramsey Amin DDS

      Hello DeeDee

      Some areas of bone reconstruction are extremely difficult. But just because one dentist had 2 failures does not mean that another will not have success. I would suggest a second opinion. Seek out a dentist who is very skilled in implant dentistry/bone grafting.

      Consider having L PRF and/or other growth factors added to your bone graft in order to make it heal better. Also consider an onlay block bone graft. The skill of your surgeon unfortunately will play a massive role on your ability to have success. Of course you have to be a healthy individual that does not smoke, do recreational drugs or have other complex medical issues.

      These web links may help you:
      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?

      What is a “Block Bone Graft” Associated with Dental Implants? — Video

      Very respectfully,

      Ramsey Amin DDS
      Diplomate of the American Board of Oral Implantology/Implant Dentistry
      Fellow of the American Academy of Implant Dentistry
      Burbank, California

      Reply
  169. Scott Doris

    Hello Dr Amin

    I have had a rough year with my front tooth, 5 years ago I was in a car accident and cracked it right in half the dentist determined the tooth was okay so he just filled the half with some sort of tooth like material and i went on my way.
    Untill 1 year ago the tooth started to get sensitive so the dentist decided to do a root canal/crown on the tooth. The gum around the tooth never healed properly after the crown was placed it was very recited and sore at times, after going back many times they decided i should have a crown lengthening done which i didn’t understand why because my gum was completely fine until this root canal/crown was done. So i went to a new dentist, endodontist and another specialist and they determined that the entire tooth be extracted and have a dental implant put in. So 3 days ago now i had the crowned tooth extracted with particle bone grafting done, the root of the tooth was very discolored.
    I am so worried about my gum around the area if it will heal or not, i wish i could show you pictures of the area. I also have a flipper to wear when i go out. I am a business university student and I am so worried about my appearance now that my front tooth is totally gone. my speech is different.
    Mostly i am worried about the look of my gum around the area, do you know if it will go back to normal over time? maybe by the time the implant is ready to go in?
    Should i be wearing this flipper all the time? does it affect the healing process?
    I HAD a great smile until 1 year ago this crown/root canal was done, now I am super self conscious about cracking a smile and showing my gum area at the top of my mouth, its awful…

    Reply
    1. Ramsey Amin DDS

      Hello Scott,

      Sorry for the delay. Just catching up after the Thanksgiving holiday!!

      It sounds like you had a socket bone graft. The chance of success is quite high as long as you’re healthy. Typically you want to wait 3-6 months before you place the dental implant in this position. It sounds like the right decision was made to remove this tooth. Sometimes cracks cannot be seen or they get larger very quickly.

      After 3-6 months I would suggest you have a 3-D scan done to evaluate bone density. You may want to consider computer guided surgery in order to place the implant in an extremely precise position if this is a front tooth with a potential gum issue. Oftentimes I will combine a gum graft to be done at the same time that the implant is placed if the area is deficient in gum. Sometimes a secondary bone graft needs to be done at the time of implant placement. A front and center tooth requires a lot of patience to get it done properly.

      I understand you want to get this done as soon as possible but do not go too quickly. You can definitely achieve a great smile, it just may take some time in several procedures to get things back to near perfect again. Front teeth dental implants are extremely complex but they work very well. You’re doing the right thing, hang in there!

      Here are some examples in my smile gallery and some links to help you:
      Computer Guided Dental Implant Surgery, Things You Need To Know

      3D Scan

      Smile Gallery

      Gum Grafting

      Very Respectfully,

      Ramsey Amin, DDS
      Diplomate of the American Board of Oral Implantology/Implant Dentistry
      Fellow of the American Academy of Implant Dentistry
      Burbank, California

      Reply
  170. Wyatt Brown

    Dr, Amin,
    I found your website useful and you to be responsive so I thought I’d give it a shot.
    I had a molar removed and a graft done for an implant 2 weeks ago.
    I was prescribed Vicodin along with ibuprofen and that worked well…..until the vicodin ran out. Now the pain is extreme again. What can I use in lieu of vicodin?

    Reply
    1. Ramsey Amin DDS

      Hello Wyatt,

      Thank you for noticing. I try to get back to people as timely as possible. There are a few hundred comments to respond to on a weekly basis!

      What you really need is a visit with your dentist ASAP. Typically people do not have pain worthy of narcotic pain medication Vicodin at the two-week mark. My guess is you have some sort of infection which presenting itself as pain. You may need the bone graft removed which is called a debridement and/or be placed on a cocktail of antibiotics. You may want to consider a culture and sensitivity to determine what type of bacteria may be present. Sometimes there are very unusual bacteria that do not respond to the typical antibiotics that we prescribe. Fortunately most respond to the basic antibiotics though.

      This is very unusual especially if this was a very basic type of socket bone graft. I could see this being the case if this were a major graft using several blocks of bone combined with extraction of 10 or more teeth.

      An excellent way to reduce pain is using IV sedation and having intraoperative intravenous steroids. This can also be combined with using blood concentrates such as L-PRF. Most of the time to my practice, people are surprised how little pain they had.

      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?

      3 Myths About Tooth Implants -Pain, Expense and Time – Burbank Dentist Explains

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

      Good luck. I hope you get better soon.

      Respectfully,

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

      Reply
  171. Michaela

    Hi Dr. Amin-
    After reading through all the emails, my questions seems so minor! Thank-you for all the advice you have given to everyone!
    I am 40 year old healthy female.
    10yrs. ago I had left bottom wisdom tooth removed (it was “communicating”) resulted with 3 months infection and still current numbness of lower left lip and chin.(history for current dentist)
    On August 18th 2014 I had right lower wisdom tooth extracted (it was “communicating”) I was awake during procedure as I do not like to “go under” it took 2 hours from the time I was numb until the time entire tooth was out…Doctor said it was the hardest one he ever had to extract…the root of tooth was black. Doctor installed synthetic bone graft. Also started me on steroids for about a week and penicillin and ibuprofen and vicodin. The extraction site with sutures healed nicely… I have been on 2 rounds of penicillin since then as the bone graft site in my jaw becomes enlarged and painful all the way up to my temple…I just finished last round of antibiotics on 11/7/14….Doctor said sometimes people have to do antibiotics up to four times after dental surgery… I quit smoking on 10/28/14 (switched to vaporizing) so hopefully that will help… Currently I take 1600mg ibuprofen in am and again about 5pm along with 1500mg Tylenol and Tramadol 37.5/325…Its the pain from my jaw to temple that seems never-ending without meds…. I asked my dentist about possibly stronger antibiotics and he said my body needs to build anti-bodies to fight it…He also said my facial and head pain was due to trauma to my facial muscles during the surgery but should be subsiding when infection is gone… Currently I have a hard ball on graft site of my jaw and still looks enlarged but not super noticeable to other people unless I point it out…My entire lower lip and chin are completely numb (they match now!) but that is ok- I expected that was probably going to happen…The PAIN just seems a little too long….Am I being unrealistic?

    Reply
    1. Ramsey Amin DDS

      Hello Michaela,

      Wow… Your situation and outcome is extremely uncommon and unfortunate. If you truly have a continued infection that is nonresponsive to traditional antibiotics, I would suggest that you have a culture and sensitivity done of any active pus. This will determine the exact type of antibiotic that can be used to kill the bacteria that are specific to your mouth. The steroids are a good idea. Be careful not to take too much ibuprofen and Tylenol as they can cause liver and kidney damage if taken for too long in high doses.

      I’m not a big fan of doing bone grafts into wisdom teeth sites. A bone grafts an atypical socket in my office is a procedure of minimal pain. Bone grafts in wisdom teeth can take too long to heal and that is one of the reasons why I would rarely do this procedure. If anything I would take L-PRF and place it into the socket.

      It is unfortunate that you have nerve issues after what is typically a very straight for procedure. If the bone graft is not healing, I would remove it ASAP.

      Short Dental Implants – A Unique Solution to Avoid Nerve Damage

      Nerve-Repositioning for Lower Dental Implants

      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?

      Respectfully,

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

      Reply
  172. mike

    How does one determine whether a particulate graft to add width to a bicuspid site is healed, done consolidating, and ready for accepting an implant?
    And how does one determine how much (new) bone is available to support an implant in this area?
    Will another cone-beam CT be required and do CBCT images allow one to distinguish old bone from new bone?
    Thanks in advance for the help!

    Reply
    1. Ramsey Amin DDS

      Hello Mike,

      Bone grafts in the bicuspid areas generally heal in 4-6 months. Healing is determined by evaluating your mouth clinically and by x-ray preferably 3-D CBCT scan. This will allow a determination on how much new bone is available to support the implant. Depending on the type of bone use, the 3-D CBCT and sometimes distinguish new bone from old bone. For example, synthetic bone is quite easy to differentiate on x-ray while human bone is not.

      In my office, every patient will have a 3-D scan done after a bone graft is done. This allows me to do virtual computer surgery and plan your surgery precisely.
      Cone Beam 3D Scan X-ray – Basics For Dental Implants

      3D Scan

      Computer Guided Dental Implant Surgery, Things You Need To Know

      I hope this helps you,

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

      Reply
  173. Victoria

    hi doctor.. I was involved in a very fatal car accident in August.. I lost all my upper front tooth like 6 of them. I’m 19 years old, I was advised to gt implant but my dentist told me i lost a lot of bones in my mouth so I’d hv to firstly do bone grafting bfr I can gt an implant. I want to find out how long the whole process of bone grafting nd implants is going to take. Because this has not only affected me physically but also psychological. I’m really depressed that I can’t smile or laugh

    Reply
    1. Ramsey Amin DDS

      Hello Victoria,

      I’m so sorry to hear about your accident. Sounds like you will have a complex and lengthy dental reconstruction. Generally speaking in your situation bone grafting will need to be done first and allowed to heal for 4-7 months. After that dental implants will be placed which will be allowed to heal for 4-6 months. The teeth can begin to be made after the implants have osseointegrated to the bone. Oftentimes temporaries are used to measure and make the smile correct. Expect the process of making your new teeth to take several months also.

      Smile Gallery

      Hang in there, I will keep you in my prayers and thoughts.

      Respectfully,

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

      Reply
  174. Kristine

    Why would a person have, “bone loss around the implant”, after getting a bone graft?
    I had #5 & #12 pulled, grafted, then, healing process of 4 months.
    I was told I was ready for the crowns May 2014.
    September 2014, #5 is wiggly. I thought it was the crown.
    X-rays taken by my dentist, showed, “bone loss”. He said, “I have never seen this before.”
    Everything was removed by the peridontist, October 4, 2014, and he graft it that same day. There was no infection.
    Because it failed so quick, what are the odds, it will fail again?
    My dentist will give me the next crown, “no charge”, as he knows how expensive this process is, and my insurance kicked in for (1) .
    What else could I do if he says he does not want to try? I cannot be left without any tooth on the side of my profile.

    I now have to worry until December 15, 2014.

    Reply
    1. Ramsey Amin DDS

      Hi Kristine,

      Unfortunately failures can and do happen. Dental implants have a success rate of approximately 98.5% when done with a very skilled operator. Bone graft success is more variable than 98% and is more like 85%. Unfortunately you or one of the small percentage that this procedure did not work out for. There are host of variables in why this could happen not limited to, non-integration of the graft material, infection, peri-implantitis for no reason, oversized implant, not enough bone on the outer wall , abutments screw not completely seated or tightened, non-integration of implant parts, and about 30 more reasons including your health and habits such as smoking.

      Don’t lose hope that the second implant will fail again. Most of the time when this occurs, the second implant is successful. I know you’re frustrated, but just try to be patient as this is definitely the best procedure you can have done.

      This post may help you also: What is Peri-implantitis and What Do I Do About It? – Bone Loss Around Dental Implants ~Burbank Dentist, Ramsey Amin Reviews

      Losing Bone on My Dental Implant -Too Much Cement?

      Very respectfully,

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

      Reply
  175. Stan

    Apologies – resubmitting as I left incorrect email address

    My dentist did tooth extraction, bone graft and implant ( base) insertion all on the same day. After 2 weeks he had to take the implant out, saying it had not healed correctly. He further explained this was unusual (less than 1 in 10 chance) and usually in the case of smokers or diabetics. I do not smoke and intend on being checked for diabetes now. I asked him if he would fill the hole left by the implant with granules, but he declined. I am concerned this area will not heal at all now and have lost confidence that I can be treated. Would you recommend abandoning the implant idea ( I am virtually there already) and hoping my jaw will somehow heal?

    Reply
    1. Ramsey Amin DDS

      Hello Stan,

      Immediate dental implants need to have enough bone for the implant screw to achieve a high degree of tightness when it is placed. If it is not tight when it is placed, it doesn’t matter if you have diabetes or not, the implant is likely to fail early on. It is not uncommon with a very skilled implant dentist for them to do simultaneous extraction, bone graft, implant placement and sometimes even the abutment and a temporary crown. This has got to do mostly with the training, skill, judgment and experience of your dentist. Sometimes things just don’t work out despite excellent technique too.

      If the implant was only remove just 2 weeks ago, it is not too late to have a bone graft placed. If this is an upper front tooth, this bone graft is much more important than a back tooth.

      These web links may help you:
      Burbank Implant Dentist Explains: Immediate Front Tooth Replacement with Bone Expansion Grafting

      Burbank Dental Implant Specialist: Review of Immediate Dental Implant Considerations

      The “Void” Bone Graft for Immediate Single Implants – American Board Diplomate Explains

      Rationale and Costs –Immediate Same Day Extraction and Back Tooth Molar Implant vs.Waiting

      Broken Tooth Replaced With Immediate Dental Implant -X-ray Series

      Immediate Dental Implants…Things To Consider

      Don’t give up on the idea of having a dental implant. It is still your absolute best option. Just because the first one didn’t take, I doesn’t mean that the second one will do the same.

      Very respectfully,

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

      Reply
  176. Stan

    My dentist did tooth extraction, bone graft and implant ( base) insertion all on the same day. After 2 weeks he had to take the implant out, saying it had not healed correctly. He further explained this was unusual (less than 1 in 10 chance) and usually in the case of smokers or diabetics. I do not smoke and intend on being checked for diabetes now. I asked him if he would fill the hole left by the implant with granules, but he declined. I am concerned this area will not heal at all now and have lost confidence that I can be treated. Would you recommend abandoning the implant idea ( I am virtually there already) and hoping my jaw will somehow heal?

    Reply
    1. Ramsey Amin DDS

      Hello Stan,

      Immediate dental implants need to have enough bone for the implant screw to achieve a high degree of tightness when it is placed. If it is not tight when it is placed, it doesn’t matter if you have diabetes or not, the implant is likely to fail early on. It is not uncommon with a very skilled implant dentist for them to do simultaneous extraction, bone graft, implant placement and sometimes even the abutment and a temporary crown. This has got to do mostly with the training, skill, judgment and experience of your dentist. Sometimes things just don’t work out despite excellent technique too.

      If the implant was only remove just 2 weeks ago, it is not too late to have a bone graft placed. If this is an upper front tooth, this bone graft is much more important than a back tooth.

      These web links may help you:

      Burbank Implant Dentist Explains: Immediate Front Tooth Replacement with Bone Expansion Grafting

      Burbank Dental Implant Specialist: Review of Immediate Dental Implant Considerations

      The “Void” Bone Graft for Immediate Single Implants – American Board Diplomate Explains

      Rationale and Costs –Immediate Same Day Extraction and Back Tooth Molar Implant vs.Waiting

      Broken Tooth Replaced With Immediate Dental Implant -X-ray Series

      Immediate Dental Implants…Things To Consider

      Don’t give up on the idea of having a dental implant. It is still your absolute best option. Just because the first one didn’t take, I doesn’t mean that the second one will do the same.

      Very respectfully,

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

      Reply
  177. Janet

    Hi Dr. Amin, you have a great website, videos, and blog! Thanks!

    I’m writing to see if I should be concerned with how my bone graft is healing. I had a left rear molar extracted and a socket bone graft (from a cadaver) 3 weeks ago. The dentist put in numerous silk sutures on top of a membrane, such that it covered my whole gum area. I took antibiotics as prescribed. I had the sutures taken out yesterday (some fell out ahead of time, she said that would be OK) and the membrane also worked its way out, but I still have jaw pain. The dentist also said that my gum is healing slowly and so I am going back in in 2 weeks so she can look at it. I also think she is a novice dentist (maybe a resident?), but I’m trying not to worry about this and to trust the senior dentist who hired her! My questions are 1) is it common to have sutures cover the whole surface area of where the socket graft was done, 2) what would make my gum heal slowly, 3) is it OK to still have some jaw pain 3 weeks after procedure (I read that you said it often subsides after a week), and 4) I went to an aerobics/total body workout today and it exacerbated the pain – all the bending over and up and down in particular. Should I refrain from this type of exercise or is it actually good for the healing process?

    Thanks in advance for any input.

    Reply
    1. Ramsey Amin DDS

      Hi Janet,
      It is very common to have sutures placed over the whole surface of the socket graft. People heal slowly for different reasons and a few people will have prolonged pain which is the exception rather than the rule. If you are middle-aged female and have gone through menopause, your bone will heal differently than it did when you were in your 20s.

      I would only do exercise that you feel will not make the surgical area painful. You may have a low-grade infection that may require another round of antibiotics.

      These links may help:
      What Is A Membrane? Do I Need One For My Implant Bone Graft? My Membrane Fell Out/Sticking Out And Exposed

      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?

      Respectfully,

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

      Reply
  178. Rudy

    Hello Dr. Amin

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

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

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

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

    Reply
    1. Ramsey Amin DDS

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

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

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

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

      Reply
  179. john

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

    Reply
    1. Ramsey Amin DDS

      Hi John,

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

      Braces, Orthodontics and Front Teeth Missing From Birth…What You Need To Know Before Having A Dental Implant

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

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

      Reply
  180. justice

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

    Reply
    1. justice

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

      Reply
  181. Laura

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

    Reply
    1. Ramsey Amin DDS

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

      PRP vs. BMP (Blood Growth Factors) for Dental Implant Bone Grafts

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

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

      Reply
      1. Laura

        Thank you for the information.
        We saw the dentist a few days after my original post & despite the opening to the incision line, all appears well & no infection is present. The pontic in the retainer was filed down some & although my daughter said it never bothered her before, she reports that it feels better in her mouth.

        Reply
  182. Melissa

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

    Reply
    1. Ramsey Amin DDS

      Hi Melissa,

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

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

      Burbank Dental Implant Specialist Case Example – Lower Front Tooth With Temporary on Abutment

      Burbank Implant Dentist Explains: Immediate Front Tooth Replacement with Bone Expansion Grafting

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

      I hope this helps

      Very respectfully,

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

      Reply
  183. Christina Faith

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

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

    Reply
    1. Ramsey Amin DDS

      Hello Christina,

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

      Sinus Lift Bone Graft

      Burbank Sinus Lift Bone Graft for Dental Implants Case Example -Ramsey Amin,DDS

      3 Ways To Avoid a Sinus Lift Bone Graft for Dental Implants – Burbank Dentist Explains

      Video – Sinus Lift Bone Graft for Dental Implants

      Very respectfully,

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

      Reply
  184. Candice

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

    Reply
    1. Ramsey Amin DDS

      Hello Candice,

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

      Very respectfully,

      Ramsey Amin DDS

      Reply
  185. Sarah

    Hi Dr. Amin,

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

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

    Sarah

    Reply
    1. Ramsey Amin DDS

      Hello Sarah,

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

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

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

      Ramsey A. Amin, D.D.S.

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

      Reply
  186. Karen W.

    Hello Dr. Amin,

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

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

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

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

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

    Reply
    1. Ramsey Amin DDS

      Hello Karen,

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

      It sounds like you have a condition called peri-implantitis which formed early. What is Peri-implantitis and What Do I Do About It? – Bone Loss Around Dental Implants ~Burbank Dentist, Ramsey Amin Reviews

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

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

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

      Respectfully,

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

      Reply
      1. Karen W.

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

        Reply
  187. Diane Conrad

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

    Reply
    1. Ramsey Amin DDS

      Hello Diane,

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

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

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

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

      Very respectfully,

      Ramsey A. Amin, D.D.S.

      Reply
  188. JJc

    Hi

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

    Reply
    1. Ramsey Amin DDS

      Hi JJC,

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

      http://www.burbankdentalimplants.com/after-extraction-and-bone-graftthe-bone-is-showing-now-what-ramsey-amin-dds-reviews-options/

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

      Reply
  189. debra

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

    Reply
    1. Ramsey Amin DDS

      Hi Debra,

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

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

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

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

      Please see this link for some clarification:

      Sinus Lift Bone Graft

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

      Reply
  190. Nicole

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

    Reply
    1. Ramsey Amin DDS

      Hello Nicole,

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

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

      this link may help you with some concepts:

      Extraction Socket Bone Graft

      Very respectfully,

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

      Reply
  191. Rhonda

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

    Reply
    1. Ramsey Amin DDS

      Hello Rhonda!

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

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

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

      http://www.burbankdentalimplants.com/dental-implants-how-long-does-it-take/

      😉
      Very respectfully,

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

      Reply
  192. Alyssa

    Hello!

    Your website is fantastic.

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

    Reply
    1. Ramsey Amin DDS

      Alyssa,

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

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

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

      Ramsey Amin DDS

      Reply
  193. Jackie

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

    Reply
    1. Ramsey Amin DDS

      Hi Jackie,

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

      I look forward to meeting you
      😉
      RA

      Reply
  194. Vicki

    Dr. Ramsey,

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

    Reply
    1. Ramsey Amin DDS

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

      Ramsey Amin DDS

      Reply
  195. Vicki

    Hi,

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

    Reply
  196. Samantha Stone

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

    Reply
    1. Ramsey Amin DDS

      Hello Samantha,

      What you describe is not completely uncommon.

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

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

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

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

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

      Reply
  197. Jackie

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

    Reply
    1. Ramsey Amin DDS

      hello Jackie,

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

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

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

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

      Reply
  198. bev

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

    Reply
    1. Ramsey Amin DDS

      Hi Bev,

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

      Respectfully,
      Ramsey Amin DDS

      Reply
  199. Chris

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

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

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

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

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

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

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

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

    Reply
    1. Ramsey Amin DDS

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

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

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

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

      Reply
  200. Miriam

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

    Reply
    1. Ramsey Amin DDS

      Hello Miriam,

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

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

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

      Reply
  201. Stephanie

    Good Afternoon Dr. Amin,

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

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

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

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

    Regards,
    Stephanie

    Reply
    1. Ramsey Amin DDS

      Hello Stephanie,

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

      Reply
  202. Hanna

    Hello Dr,

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

    Thank you for taking the time.

    Reply
    1. Ramsey Amin DDS

      Hi Hanna,

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

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

      Reply
  203. margaret coleman

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

    Reply
    1. Ramsey Amin DDS

      Hi Margaret,

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

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

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

      Reply
  204. SJ

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

    Thanks.

    Reply
    1. Ramsey Amin DDS

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

      Good luck,
      Ramsey Amin DDS

      Reply
  205. Brenda

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

    Reply
    1. Ramsey Amin DDS

      hello Brenda,

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

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

      Good luck to you… Keep us all posted

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

      Reply
  206. Kathy

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

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

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

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

    Reply
    1. Ramsey Amin DDS

      Hi kathy,

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

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

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

      Reply
  207. Selene Rucobo

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

    Reply
    1. Ramsey Amin DDS

      Hi Selene,

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

      Next time, travel to Burbank. 😉

      Again thank you for your very flattering words

      Dr. Amin

      Reply
  208. Karen

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

    Reply
    1. Ramsey Amin DDS

      hi Karen,

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

      Dr. Amin

      Reply
  209. Siobhan

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

    Reply
    1. Ramsey Amin DDS

      Hello Siobhan,

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

      http://www.burbankdentalimplants.com/burbank-dental-implant-specialist-review-of-immediate-dental-implant-considerations/

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

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

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

      Reply
  210. Elizabeth

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

    Reply
  211. Laura

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

    Reply
    1. Ramsey Amin DDS

      Hello Laura,

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

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

      Saving loose teeth is never a good idea.

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

      Reply
  212. Rochelle

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

    Reply
    1. Ramsey Amin DDS

      Rochelle,

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

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

      Reply
  213. Ray

    Hi Dr. Ramsey,

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

    Thanks,
    Ray

    Reply
    1. Ramsey Amin DDS

      Hi Ray,

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

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

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

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

      Good luck!!

      Dr. Amin.

      Reply
  214. Gita

    Dear Doctor Ramsey,

    I had 2 extractions upper jaw molars on same side.

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

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

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

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

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

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

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

    Gita

    Reply
    1. Ramsey Amin DDS

      Hi Gita,

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

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

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

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

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

      I hope this helps you.

      Respectfully

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

      Reply
  215. Rex

    Hello Dr. Amin,

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

    Reply
    1. Ramsey Amin DDS

      hello Rex,

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

      Reply
  216. Joseph

    Hi Dr Ramsey,

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

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

    Is this normal?

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

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

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

    I appreciate your input and professionalism.

    Joseph

    Reply
    1. Ramsey Amin DDS

      Hello Joseph,

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

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

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

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

      Reply
      1. Joseph

        Hi Dr Ramsey,

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

        Reply
      2. Joseph

        Hi Dr Ramsey,

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

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

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

        Reply
        1. Ramsey Amin DDS

          Hi Joseph,

          It sounds like you are in good hands.

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

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

          Dr. Amin.

          Reply
  217. Paige

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

    Reply
    1. Ramsey Amin DDS

      Hello Paige,

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

      Very respectfully,

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

      Reply
  218. Anna

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

    Reply
    1. Ramsey Amin DDS

      Greetings Anna,

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

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

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

      Reply
  219. Jennifer Page

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

    Reply
  220. AD

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

    Reply
    1. Ramsey Amin DDS

      Hi AD,

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

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

      Reply
  221. Jordan

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

    Reply
    1. Ramsey Amin DDS

      Hi Jordan,

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

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

      Reply