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Bone Grafts…How Long Do They Take to Heal?

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.

(Related topic –click here)



 Factors affecting bone graft healing time

  • 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 4-6 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

Video Transcription

Hello, I’m Dr. Ramsey Amin and I’m going to speak with you a little bit about bone grafts and how long they take to heal. With respect to dental implants, bone grafting is sometimes necessary to rebuild the amount of jawbone to be adequate to replace the area or tooth with a dental implant. There’s a number of factors that I’ll cover here briefly.

One is how many walls are missing in the area where the implant needs to go. I’ll come back to that in a minute. Whether the bone graft is in your upper or lower jaw, also it depends on and is a factor on how long the bone graft will take to heal. What type of bone material is another factor. Whether or not a membrane is used to cover the implant is another factor to consider. Whether or not the bone is in a piece or a block or if it’s particulated, meaning it’s in granules.

Other issues are whether or not we’re just trying to rebuild the width of your bone or we’re trying to rebuild the width and the height of your bone, or one or the other, and whether or not we need to add gum at the same time. The number of walls that are missing. If you picture my hands as being four walls, it’s very easy to add bone to the center of those four walls. If one of those walls was missing all together, we would have to rebuild that all in its entirety. Rebuilding an entire wall or two walls that may be missing, they’re usually on the outer aspect of your jawbone, that typically takes longer to heal.

Most bone grafts, just so you know, heal in about three to four months. Some will take as long as seven to nine months. It really depends on the size, location, your medical conditions. A number of factors that I can’t say there’s one real answer, but the average is about four months for most people.

One example would be a sinus bone graft that happens to have all four walls contained. Generally speaking, those take four to six months for them to heal, to be solid enough to place dental implant. The lower jaw and the upper jaw are a bit different in their respect to how much blood flow comes to them. The upper jaw typically gets more blood flow than the lower jaw and therefore tends to heal better, faster with less problems. The upper jaw is what we call mostly marrow as opposed to cortical bone, so it does heal a bit better. There are chances of it taking much higher.

Types of bone that can be used will be covered in another blog. I’ll try to post a link so that you can cover that, but there’s basically your own bone is one option. The second option is bone from a tissue donor, a human being has passed on. Third is bone from a cow, and fourth would be synthetic types of bone. They all have different applications and different uses. One simply does not replace the other. Oftentimes I’ll mix one, two, or even three types of bone in order to make your bone graft successful.

Whether or not the bone is in a block or if it’s a particulated form has a lot of meaning also too. Typically, if we’re filling an area or filling a void, we can typically fill that with particulated bone, which kind of looks like rock salt or granules. As you heal, those granules will consolidate, become solid and just form new bone.

Other times where we’re missing most of the walls and we have to replace the whole outer aspect of the jawbone, we have to use what’s called a block bone graft, and a block would be where we take a section of bone. I’ll take a section of bone, either from where your wisdom tooth used to be or where your chin is from down inside the lower lip, actually cut a piece of bone out and replace that to a different area. It’s usually held in place by a screw and it’s allowed to mend to your jaw bone. Block bone grafts typically, depending on the area, may take shorter or longer to heal than a particulate bone graft. And again, each situation is very different.

When we’re rebuilding the jawbone, it’s much easier to rebuild the width. If you’ve lost the width of your jawbone, then it’s easier to rebuild than the height of the jawbone. Typically, if you’ve lost height of your jawbone, it may take a longer to rebuild, and oftentimes, we’ll have to combine that with a gum graph. Because if you’ve lost bone, if you think about it, the gums had to have shrank along with it. Oftentimes, I’ll take a piece of gum from the roof of the mouth or other alternatives of gum tissue and kind of sandwich it in between there in order to really rebuild the area the best possible.

But again, most bone grafts do take on average about four months. Some will take as long to seven to nine months. Very much dependent on the area that we’re rebuilding. But generally, your own bone will remodel and it will help turn over the graph material to something that’s solid and stable, and that can really allow a strong foundation for your dental implants.

If there’s questions or concerns, please leave some comments below. You don’t have to sign up at all. Just go ahead and leave comments or questions. I’ll try to get to them as soon as possible. Hope this was helpful and allowing you to at least gain some insight on how long it takes a bone graft to heal. Again, my name is Dr. Ramsey Amin. Thank you so much and we’ll see you soon. Thanks.

895 thoughts on “Bone Grafts…How Long Do They Take to Heal?

  1. Hello Dr. Amin!

    Last Friday on June 26th, I had an extraction and bone graft done on tooth #30 because it was infected. My swelling has gone down, and I am on antibiotics. However, I have dull/sharp pain here and there on my extraction site and under my jaw throughout the day and more so when I lie down. I’ve been doing okay without pain meds the last two days, but it is uncomfortable/painful and therefore why I am reaching out. Is this healing process normal?

    Thank you so much.

    1. Hi,
      I have aproplem and need any help from any one Could help
      I was having aperiapical lesion in upper jaw over 5th tooth and have done firstly root canal in 6th tooth, then mucoperiosteal flaping to ttt periapical lesion of the 5th one and put bone graft after epicoctomy of 5th tooth roots
      Nowafter one month of grafting There is hard bony localized swelling convied to and above 5th and 6th teeth with discomfort and mild pain of 6th tooth, so, I want to know thd cause? Is It normal? Does this swelling will resorbed and bone remodling will take aplace?? Please help

  2. I had the first molar on my bottom right extracted after a retreat for an old root canal failed. They also removed my two lower wisdom teeth at the same time. The old root canal got infected after the first dentist worked on it years ago and caused me a severe infection that caused me agony and was only treatable with Cirpo. When they tried to retreat it about 3 weeks ago, the couldn’t complete it due to the original dentist blocking one of the roots with metal, hence the extraction. During the root canal retreat, the inside of the affected tooth appeared black and had a horrid smell which I assume is from the original infection.

    My question is in regards to the bone graft. I had the tooth extracted about 2 1/2 weeks ago now and the bone graft placed at the same time. I was put Amoxcillin and told to rinse with salt water 4 times a day which I did. I don’t feel the area is healing as fast as it should, as I now have a gaping hole at the extraction site after the sutures fell off and I have discomfort in the area. I was put on a second course of Augmentin last Thursday and Chlorhexidine rinse and I still have slow healing and discomfort. Could the bone graft be infected or is minor discomfort in the area still expected 2 1/2 weeks in? Another side effect of the surgery is the tooth in front of the extraction is extremely sensitive and painful to tapping. It doesn’t bother me if I don’t apply pressure to it. I am going to see the dentist again tomorrow, but I want to make the right decision. He was hesitant to remove the bone graft so far, but he also agrees that this is atypical. Any advice you can provide would be appreciated.

    1. Hi Zaid,

      I am sorry are going through all of this. You may want to watch this video post post I have about antibiotics.video post post I have about antibiotics.

      Considering you had wisdom teeth extracted at the same time it is possible that you have a dry socket. It is certainly possible that you have an infection in the bone graft as well especially considering that the membrane is no longer presentmembrane is no longer present. Hopefully by the third or fourth week all pain is absent. Wisdom teeth tend to heal very slowly and I will rarely graft a socket of a wisdom tooth. In fact I do not even remember the last time I did 1. Typically I would just use L PRF platelet concentrate made from your bloodL PRF platelet concentrate made from your blood which makes the area heal much faster and reduces pain.

      I would certainly go for additional follow-ups, x-rays and possibly switch antibiotics altogether to a different family.

      Please do me the favor of following up on this post for the benefit of others.

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

  3. I had a root canal removed from tooth 19, lower molar. The doctor said all necrotic tissue and root fragments were removed and everything cleaned well with debridement, ozone, colloidal silver, and my blood plasma was even injected prior to putting down the bone graft and a membrane. 7 days after the procedure an opening began to form and the white membrane began to disappear and opening began to develop. We are two weeks out and the pain is still moderately bad with me taking motrin 200 every 12 hours and on second round of amoxicillin. When the motrin wears off the lower gum swells and throbbing/pulsating feeling occurs. I had F/U yesterday and was told to give it more time to heal and continue Ab and motrin another week. I was also told that me using colloidal silver 2 times a day may have caused the graft to fail? Please give me your opinion on the pain and or graft failure and what is the best way to tell if the graft is failing? Thank you so much.

  4. After implants and a bone graft of the lower ridge is done how long do I have to wait to start wearing my denture again?

    1. with the worst possible thing you can do to wear a flipper or denture on top of an implant or bone graft. Please read this article that may help you. Ideally your denture is anchored to some remaining teeth or to other implants to keep it off of the gum rather than riding on top!!

      1. I recently had a baby tooth extracted with a bone graft. Inside where the tooth was extracted I see white stuff is this normal? What is it? I also got stitches but they fell out a week after my procedure. My dentist said it’s fine just take ibuprofen and salt & water rinses. But I do still see red around extracted area but no pain. Is ok to get a cleaning done in that area? Thank you

          1. It’s been five months since I had bone grafting it blew out and needed a second surgery there is still an open hole from my gums to my nose and just yesterday my cheek started swelling again

      2. Hello,

        On Tuesday I recently got bone grafting done & the spot where the bone grafting was done in the socket is a yellowish color. I’m not sure if it is yellow pus but it could be. As well as the tooth next to where the bone grafting was done is throbbing a bit. Are these signs of an infection?

      3. I just had a dentist call my husband to tell me to keep my bottoms in, w adhesives. I just had 3 bone grafts w block. Needless to say, I was mutilated. I went back a week ago after my jaw, cheek, and neck were exposed. I am stitched back “together”. 7 days later there is still no gum over the bone. Will it grow? 2 week out pain is very high!

        1. Yikes 😳. This sounds really bad. Dentures are not to be put over block grafts. The gum will not grow over the bone.

          Can you give me more details??

    2. I’m waiting to get my implant … I’m 4 months out from having my bone graft … but why is my gum (top front tooth ) sunk in ??? The gum looks sucked in compared to the other front tooth beside it . Is this normal?

    3. Is my bone graft becoming infected? 18 extraction grafting done May 29, endo recomened because dark spot on front root near nerve suspected infection to be cause of numbness on chin and burning sensation on gums. OS was hurried and pulled tooth without any finesse thought he would break jaw, then I don’t think he cleaned out sockets, I don’t remember any digging/ scraping/ rinsing/ suctioning, within minutes he placed graft and sutures, and they rushed me into lobby. Day 1 max pain, day 2-3 good just sore no other concerns, day 4-5 started getting original symptoms numbness on chin again and a new pain in 18 site that I describe as a hollow pressure pain similar to a sinus infection pain that hits me with every step while walking and every bump in road while driving. Pain is not max, maybe 3-5 level. I fear he left infected tissue under graft. How can I know? X-ray? Or would I get max pain if this is infected under graft?

      1. It sounds like an UPPER tooth radiating to the bottom.

        How is it now?

        Bone graft Infections don’t cause the type of pain you describe.

  5. Hi…I had a large dentigerous cyst 4 x 6 attached to a horizontal wisdom tooth that was way down in my jaw. I’m 58 years old. Oral surgeon removed tooth and cyst and had bone graft. It’s been about 6 weeks now and still have pain. Two weeks after I got my stitches removed all was perfect. Oral Surgeon said to eat whatever I wanted. The next day I bit into a chicken sandwich and heard a horrid crunch and thought I broke my jaw. She did an xray and said everything looked good and it was my jaw joint. 4 weeks later I still have pain near bone graft, not in jaw joint. What could be causing this. Surgeon told me to cut my food in small pieces and eat soft. I still have pain when I eat or talk too much. How long will this go on?

    1. oftentimes a dentigerous cyst occupies such a large area of the jaw. This requires much longer for the bone graft to heal. Think of it like cooking meat… The outside Cooks quickly while the inside may still be rare. The rare inside still needs time to convert to real bone. I would wait at least 9 months before reevaluating for an implant if it is necessary

      1. About four months ago I had three bone graphs one in the lower bottom one in the upper right and one in the right bottom they seem to have healed up well however this experience has been the worst in my 69 years of living. The pain seems to jump all around my mouth one day it’s behind the front teeth in the roof of my mouth another day it’s in the Kanau or trench at the bottom of my front teeth inside the lower lip. Nothing seems to indicate infection. I brush and floss regularly and salt water rinse. My mouth is extremely dry. I drink lots and lots of water. Also I do unconscious sucking in my mouth . Is this just the whole mouth trying to adjust at different points on different days to a foreign substance. It’s every day going on five months. I take morphine for the pain but it doesn’t seem to help. It’s not stabbing pain it’s just constant underlying pain. It’s become intolerable. What can I do please!

        1. Something is very wrong here. I am guessing that perhaps all of the inflamed/infected tissue may not have been removed at the time of the extraction leaving some sort of avoid between the bone graft and your native bone. This will prevent it from integrating into you. I would suggest a consult with a dental implant specialists and a 3D CBCT analysis. In 20 years of doing these procedures I have never had a patient with your description. Of course there are very rare instances where somebody can develop a chronic bone infection such as osteomyelitis but that would oftentimes results in numbness and/or a broken jaw even. Please see somebody with a lot of experience in this field. Keep me posted please.

        2. Something is very wrong here. I am guessing that perhaps all of the inflamed/infected tissue may not have been removed at the time of the extraction leaving some sort of avoid between the bone graft and your native bone. This will prevent it from integrating into you. I would suggest a consult with a dental implant specialists and a 3D CBCT analysis. In 20 years of doing these procedures I have never had a patient with your description. Of course there are very rare instances where somebody can develop a chronic bone infection such as osteomyelitis but that would oftentimes results in numbness and/or a broken jaw even. Please see somebody with a lot of experience in this field. Keep me posted please..

    2. This just happened to me as well. I was eating a small piece of BLT (bacon wasn’t crispy) and I felt a pop near the bone graft. I think I broke it but the oral surgeon did an xray and didnt see anything. Now I have this grinding pop every time I open my mouth wide.

  6. Dear Dr. Amin,

    Thank you for this wonderful and long-running blog.

    I had a failed root canal on tooth #2 with root abscesses that was extracted 5 days ago, followed immediately by a bone allograft. I also took clindamycin starting 1 hour before the procedure and continue on it now.

    For the first 3 days my pain was minimal. However, starting on day 4 the pain increased along with a sense of fullness in my maxillary sinus. Today, the pain was significantly worse and radiates to my ear. However, the wound looks ok to my wife (a pediatrician) who says that the sutures are intact, the membrane isn’t showing, and other than local swelling the wound appears ok.

    Is it within the range of normal to have escalating pain and swelling 4-5 days post-op? I would have expected this to be getting better, not worse.

    Thanks very much for sharing your insight.

    1. Not uncommon But typically upper teeth don’t hurt as much as lower teeth. I would go in for a follow up visit

  7. Thank you so much for answering these questions. I had a dental bone graft on December 10th to prepare for dental implants, to replace teeth #17 and #18. My recovery was slow. I was still in pretty big pain on days 5-7, but then things started to improve, although after 2 weeks, the lump on my jaw never went down completely – but maybe 2 weeks is still pretty early for healing. Anyway, yesterday, on Christmas day (of course!), I started to experience pain and swelling all day and started taking ibuprofen/tylenol alternating to be able to sleep that night. I called my surgeon this morning, and he was able to see me at 8am (very thankful for that). He said I had a “small” infection. He removed my sutures and irrigated my wound. I could taste/smell – gross – a small amount of pus when he took the sutures out. Then he gave me a prescription for Clindamycin, 300mg, 4x/day for a week. I go back and see him Friday. I was in so much pain AND had to take my young children with me to see him this morning, so I didn’t really have my wits about me. I have two questions: 1. In your experience, does this happen often? I was reading online that if the infection is actually IN the graft, it will most likely have to be removed and redone. But if it is more superficial, irrigation and antibiotics could work. What do you think? Why would I have an infection after 2 weeks, even though the would was sutured up tight. 2. He did not take any scans or other X-rays today. I am assuming he will on Friday, but if not, should I request them? 3. What about more aggressive treatment, like hyperbaric oxygen therapy? I know this might not have been able to be prevented, but I am just so bummed and full of anxiety thinking about having to have the bone graft removed and done AGAIN. This has not been an easy experience for me at all. Thank you very much.

  8. Dr. Amin,

    Thank you so much for answering these questions. I had a dental bone graft on December 10th to prepare for dental implants, to replace teeth #17 and #18. My recovery was slow. I was still in pretty big pain on days 5-7, but then things started to improve, although after 2 weeks, the lump on my jaw never went down completely – but maybe 2 weeks is still pretty early for healing. Anyway, yesterday, on Christmas day (of course!), I started to experience pain and swelling all day and started taking ibuprofen/tylenol alternating to be able to sleep that night. I called my surgeon this morning, and he was able to see me at 8am (very thankful for that). He said I had a “small” infection. He removed my sutures and irrigated my wound. I could taste/smell – gross – a small amount of pus when he took the sutures out. Then he gave me a prescription for Clindamycin, 300mg, 4x/day for a week. I go back and see him Friday. I was in so much pain AND had to take my young children with me to see him this morning, so I didn’t really have my wits about me. I have two questions: 1. In your experience, does this happen often? I was reading online that if the infection is actually IN the graft, it will most likely have to be removed and redone. But if it is more superficial, irrigation and antibiotics could work. What do you think? Why would I have an infection after 2 weeks, even though the would was sutured up tight. 2. He did not take any scans or other X-rays today. I am assuming he will on Friday, but if not, should I request them? 3. What about more aggressive treatment, like hyperbaric oxygen therapy? I know this might not have been able to be prevented, but I am just so bummed and full of anxiety thinking about having to have the bone graft removed and done AGAIN. This has not been an easy experience for me at all. Thank you very much.

    1. It happens! It sounds like your are being managed correctly. You do not need any aggressive treatment or an x-ray yet. This does NOT mean that you will need to have a redo since this is being managed at an early stage. This too shall pass. 😉

  9. Hello Dr. Amin,
    I has sinus lift bone graft surgery , done on 14th of December. It went well . No swelling or bleeding. Was taking Ibuprofen 3 times a day aling with anti biotic. I do have mucus draining from the back, so I do have to cough it out. I do have to apply normal pressure. Now the problem is , some dark brown chocolate granules are coming out in the mucus from the 4th day. Everyday it comes out at least one time. Now it is about 5 days of this happening. My dentist office is closed for holidays until the 2 nd. Since it does not seem life threatening, I did not call the dentist.

    Could you please tell me, if this is normal. Does the liquid bone get hard or not. I am 70 years old. I do not want to go for the same surgery if it can be helped. I am desperately looking for answers. Please tell me what should I do.

    1. In some cases this can be normal. I would suggest you take an over the counter decongestant for several days as long as your doctor clears this. Don’t blow your nose! Call the dentist. I’m sure they would want to hear from you…I would 😉 The graft is not liquid. Sinus bone grafting is really predictable when it is indicated and the dentist has experience.

  10. I had an extraction of a molar (behind my incisor) 4 days ago, as well as a deep cleaning/scaling root planing, under IV sedation because of an extreme dental phobia that caused me to avoid any dental care for a decade. The pain had settled to almost nothing before the procedure, but my mom was freaking out and insisting I needed it done. I was given penicillin (a week’s worth, 4 times a day) because of some infection that was involved, and percocet for pain, as I have about zero tolerance for dental pain. The endodontist only gave me 10 doses of pain meds, which said on the bottle “take every 4 hours as needed” and was reluctant to do so to begin with. I’m still in pain at the extraction site, and I’ve been in tears twice, but the second prescription, which my mom had to beg for, was written in such a way that it cannot be filled until the pharmacy opens on Saturday. I requested no vicodin because I (and oddly, a friend of mine) both had issues with impulsive shopping on vicodin, and I wanted to avoid another debt I can’t afford. Is it normal for dental professionals to shrug off pain management in this way? I had a bone graft and am supposed to get an implant, as the location of the missing tooth is making me reluctant to leave the house or open my mouth with the visible gap, and it’s causing a speech impairment with the letter S (which I never realized until now was used so commonly) and I’m reluctant to even go to the follow up appointment at this point because I’m in pain and that’s not being addressed now, and I’m terrified of having to experience more pain. I’ve been taking prescription strength ibuprofen to help my pain level enough to sleep, but it’s tearing my stomach up, and I’m afraid to eat anything more solid than mashed potatoes and ice cream.

    1. Clove oil mixed with some coconut or olive oil on a cotton ball placed in mouth over area for 10-15 minutes would help immensely with pain! Too bad the oral surgeons don’t recommend natural remedies but they do sell this At cvs

  11. Hello, I am 55 years old I had an infected tooth upper left side molar had to wait a week to get it removed by an oral surgene. During that time went to hospital 3 times from the excrutiating pain. was going into my eye my forehead my lower jaw and chin and neck. They numbed me each time gave me pain pills sent me on my way. Finally tooth taken by oral surgene 1 week later used laughing gas was hard extraction broke apart thought he was going to brak my jaw. He then stuffed bone grafting material into the hole left by infected roots and some stiches. Told me to keep taking the penicillin the hospital had given me a week before which would be for another two days and to just use the pain killers the hospital had given me in case of pain which was 800mg ibuprofen, and a couple of hydrocodeine I had left they were 10mg. 325. Im home from surgene can see white bone like material that they put in holes am in pain but not like before tooth was pulled. But my lower jaw and chin seem strange almost swollen or numb ish into my chin. They are supposed to take the stiches out in ten days. Is this normal to feel and I still have throbbing in my jaw as well, is a little normal and for how long should I be concerned. Im pretty exhausted and beat up from the week before this was pulled no sleep horrible pain etc.. neck is stiff and sore but don’t know if this is pulled tooth related or just beat up from everything. Also oral surgene said he would not pull this tooth unless he putt bone in the hole, but my insurance denied the claim and said it was not medically necessary how can that be if he wouldn’t even do it it must have been necessary. please help so confused. One last thing it’s been about 20hours now should I take the gauyze out of the hole where the tooth was pulled im afraid of dry socket will it heal if I keep the gauze covering the hole. I just don’t know when I should be worried about the fact that the penecilini the hospital gave me may not have been working and the oral surgene did not prescribe anything since I had taken it for 8days already.

    1. It would’ve been best if you would’ve had sedation with an intravenous steroid to help with postoperative pain. I know it’s too late to tell you this but it helps tremendously. Most of my patients rarely have pain even after 10-12 implants are placed. It sounds like your whole-body needs a break.

      Dental insurance companies deny things all the time. That does not mean it was not necessary. Doing a socket preservation bone graft is standard of care and is the right thing to do in most cases.

      No reason to place gauze for 20 hours. 3-5 hours is sufficient. Dry sockets don’t occur on upper teeth.

      You should be seen for a follow-up to pull your mind at ease

  12. Hi there! I had an implant placed 3 weeks ago in the #7 location. I had no pain when the implant was placed but over the past 2 weeks I notice a sort of mild sort of burning sensation and pressure in my cheek bone on the side of the implant and just a mild pressure in my cheek bone and heading up towards my eye. I also have a little pressure at the base of my nose on the side where the implant is. My right side of my face, the side that the implant is in, just feels different and not relaxed. Would you know what is causing this and should I be concerned?

  13. Dear Dr. Amin,
    Last Thursday, I went in to my dentist to have two teeth extracted … one upper right and a lower left molar (I believe #18). When I woke up, the dentist had removed three teeth (two lower molars and the upper right tooth). He explained that the molar next to the one that was initially to be removed was also cracked, so he took them both. He also explained that he had to do a dental bone graft in the socket of the two molars, so implants can be done later. How long does it take for the jaw to heal after this type of procedure? My lower jaw (under the two molars that were extracted) has been throbbing for five full days after surgery. I went back to the dentist and it’s not a problem with the socker, as that appears to be healing well (stitches in good shape, no dry socket, etc.) What is causing the lower jaw pain and how long will this go on? I can’t continue to live on pain medication and my jaw feels like it will will break every time I crack a smile, laugh or even sit down in a chair. Is this pain normal five days after the extractions and dental bown graft?

    1. ssomething is not right. You should not have that much pain. You probably have a dry socket underneath the bone grafts. No way to really tell the. I’m assuming you’re on antibiotics as well. Go and see the dentist. Fortunately time heals all wounds and you will get better but this type of pain is worthy of a follow-up visit. It’s not the bone graft causing the pain…. it is the extractions that caused this

  14. Dr. Amin –

    5 years ago I had the left side two back bottom molars removed (# 18 and 19). I had an implant placed in one of the locations (#19) The location that did not receive an implant has lost a lot of bone.

    When I went to a periodontist- they notice the bone loss but stated bone grafting would probably not work. And they suggested I do gum grafting over 3 other teeth that have fillings near gum line.

    Should I receive another opinion? I am very concerned about the amount of bone loss and having gum grafting over fillings.

    I wanted to have bone grafting and an implant placed.

    Thank you so much – Debbie

    1. another opinion!! YES ……….there is tremendous variability and clinical expertise, training, judgment in building bone back in the back of your lower jaw. It is consider the most difficult area of all. For me these are routine procedures to build bone back through block grafting or expansion. There are about 20 different ways to do this but you’re implant dentist has to be very skilled for this to happen.

    2. I have receding gums just on lower front teeth along with bone loss. Teeth are not lose or decayed.
      Just brothers me.
      I have my teeth cleaned every 3 month’s
      I was wondering if bone graft and gum graft can be done with my teeth still there?

  15. Hi Dr. Amin! I wish I lived near Burbank so I could see you! You are phenomenal and like a guardian angel for answering all of these questions from total strangers.
    I had a failed root canal on tooth number 28. The tooth fractured. I went to an oral surgeon to have it extracted 3 days ago. Since I wanted an implant, the doctor recommended to fill the hole with bone. He used human bone I’m assuming from cadavers. The tooth he extracted had been infected and I had been having pain for several weeks. Within 5 minutes of leaving his office while still very numb I began experiencing excruciating pain level 9 or 10 out of 10. I have had four other tooth extractions but never with filling the hole with bone before. Never ever felt anything like this! It felt like I had a hole in my tooth that someone was pouring icy cold water into. 3 Advil didn’t help. took 5 mg codeine an hour later and that took the edge off but still about a 7 for pain.
    The next day was much better but still if not on 3 Advil it was a seven or eight. On three Advil about a five level of pain.

    I was not on antibiotics. But I did get that anti-bacterial prescription rinse which I began on Saturday the day after surgery. Twice a day. Three days later, today,
    Pain is still a seven or an eight without Advil. With Advil still about a 5 or a 6.
    My dentist, not the oral surgeon, prescribed a z-pack tonight. My oral surgeon had said Z Pack could not do anything for oral bacteria but I am allergic to penicillin. I also had very bad reaction to clindamycin.
    I saw the oral surgeon today and he removed the glue he had used to seal it since it was flapping and very uncomfortable. He said it looks great and no sign of infection and exactly how he would want it to look at this point in recovery. He thought the pain was very unusual but thought maybe because it was so inflamed and this tooth is so close to a nerve perhaps it was getting pain from the nerve or perhaps my gums are still getting used to this bone as he said he had packed a lot of it in there.
    My dentist thinks if it’s not better in 2 days I should have all of the bone material removed to put medicine in for a dry socket.
    But the oral surgeon said it’s impossible to have dry socket with the bone material placed in there at time of extraction.
    My question is am I having so much pain because of an infection? Will the z-pack do any good? Should I get the bone removed because there is something clearly wrong? Is my gum rejecting the bone material? could he have packed too much bone material in there? He was also pressing very hard. If there is too much bone material could that permanently be pressing on a nerve?There is no oozing or any other physical sign of infection. should I get all bone material removed to resolve my pain is there might be something wrong with whatever method he used?
    Why am I having so much pain? Also as a side note should I be doing warm salt water rinses? Neither doctor recommended this but I’m reading online that it’s a good idea.
    Thank you so much for your inside as I don’t know what to do about this constant pain and do not want to be taking Advil 24/7 as it’s already starting to hurt my stomach.
    With much gratitude,

    1. more in agreement with your oral surgeon that I am with your regular dentist. Even though your allergic to a Z-Pak you should consider Ceftin as an antibiotic although there is a 10% chance he may be allergic to that as well. My guess is you’ve did not bleed too much from the extraction and your bone is kind of dry. It will heal. Give it time. This is very unusual but is more related to the extraction than it is the bone graft. Don’t give up just yet. It will heal unless you have some sort of crazy medical problem that you are not aware of. You should be doing follow-ups every week and rinsing with Peridex chlorhexidine rather than salt water. Hang in there and thank you for your kind words

    2. Hello
      I’m going through the same situation right now and I had the tooth extracted and bone grafting done on Tuesday and today is Sunday and the pain is still unbearable. My dentist won’t do anything to help and I was wondering if you got any better and if so what did you do? I’m considering going to another dentist just to find relief.

  16. Hi!

    About 1 week ago I had a broken side molar removed and bone graft in the area. I went back for a check up with the surgeon after 4 days and he said there was minor ulceration, but it seemed to be healing okay. I started eating some very light, soft foods today and the area feels a little strange (like there could be a hole in the graft or something) and some of the stitches fell out after eating. Is this normal? I’m very nervous to eat anything or have any food particles get near the bone graft, but it’s been very difficult to eat. Any advice is much appreciated !!

  17. Hello! I’ve had two implants and bone grafts done about four weeks ago, top jaw. When is it ok for me to resume long distance running and weight lifting? I’ve noticed a bit of pressure in the implant and graft areas when I exercise. Thank you.

  18. I had a failed implant on my front tooth removed and a bone graft done. I was not aware the doctor would take cut the implant through the front gum (thought it would be unscrewed and bone added). I was swollen over 10 days. It is now 3 weeks and my nose is a bit spread out, and above my lip is protruding slightly more. It has negatively changed my appearance. But worse, I cannot smile correctly. I have to strain to smile and it is tight above my mouth. I cannot smile a big, wide smile like before the surgery. Could there still be swelling after 3 weeks causing this? Usually how long should this take before it returns to normal? Could this be the final results?

    1. If you had a large bone graft they may have temporarily stretch part of your inner lip to cover the bone graft. During the first 4 to 6 weeks don’t do any big smiling at all. Speak to your dentist about this. No exaggerated lip movements for large grafts.

      This should all be temporary. Some swelling can last up to six weeks.

      You will get better!!😁😁

    2. Hey Audrey how is the swollen now my name is tina and I’ve notice the same results you described above. I am one week postop.

    3. Hi, I had a tooth extracted 6 weeks ago. #3. Bone graft was placed to prepare for an implant. Today, tooth #2 is hurting everytime I bite on it or tap it. Iit just hurt when is touched.I have a Mercury feeling there.

      I am afraid that the bone graft is infected and is affecting tooth #2.

      the area where tooth #3 was doesn’t hurt. The gum at the very top next to the sinus is sensitive.

      Can the bone graft being infected at the top and affecting #2? or maybe is just #2 that happened to cause problems since it already has a filling?

      Today is Saturday and need to wait until Monday to call the doctor, but I am worried.

      Thanks so much

      1. Sometimes the bite gets off from the extraction. Just go ahead and get it adjusted before jumping to conclusions that you will
        Lose another tooth. 🤞

  19. Hi Dr. Amin. About one month ago, I had an infected front top tooth (#9) removed, bone graft, and implant placed. There was a large amount of bone loss, as the I had injured the tooth at a very young age. Bovine material, and my own bone, was used for the large bone graft. My Doctor used a very long implant screw. He was very happy with the outcome of the procedure. The two teeth on either side were prepped for crowns, and I am now wearing a temporary bridge. I have begun to feel mild-moderate pain in the area over the last few days, it comes and goes. Is this a natural part of the healing process, or could it be an infection? I have not noticed any redness or swelling. Also, I still have sutures in the area around my gumline, is this normal?

    1. It is not uncommon to still have the sutures at one month but typically that is about the time to take them out if they do not dissolve. There is a chance that you may have a secondary infection and require a second round of antibiotics. I assume you’re on a round of antibiotics the first time. Typically pain does not occur at this point. Please go in and get checked in and have an x-ray as well.

  20. I’m about to get my wisdom removed and my 7th tooth and having some bone Graf placedin there , my flight back home is 2 days after this ? Will I occur any problems while flying and if so what kind of problems ? Will I be in pain due to the cabin being pressurised and being 10,000ft

    1. You won’t have any pain related to the pressurized cabin…. just regular pain from wisdom tooth removal. Hopefully you get an intravenous steroid to help!

  21. I had a bone graft and two (2) implants and a sinus lift procedure on same day on my upper left side in March 2018. As of this writing, August 25, 2018 I go up to touch the area with my tongue where the bone graft and implants are and there is no bone. It feels like there is nothing there. What’s going on?

  22. Hi Dr. Amin

    I had my tooth extracted and the bone graft place about 10 days ago. Just saw the dentist yesterday, he said it looked good. I’m still worried for some reason. There is still like a hole there, and looks like the gums won’t be able to close around it. I was wondering how long it will take for the gums to completely close? Or what I should expect? Do the gums heal from underneath? I guess I should have asked my dentist but when he said it looked good I didn’t feel the need to ask to many questions.

    Thank you


      1. Thank you for keeping the comments on the blog. I’ve been hunting for a basic answer for about a week and many times I encounter the “we already answered this” but not record of the answer. I was able to read this blog and get all the answers to my questions and some questions I need to remember to ask my dentist at my next followup.

  23. On August 1, 2018 (today is 8/17/18), I had a sinus lift, bone graft, and implant. The gum above the surgical site is swollen. I am suffering from horrible sinus headaches and sinus pressure – causing the tooth next to the surgical site ache badly from pressure. I am taking over the counter advil sinus and cold medication daily which helps somewhat. Is this normal after 2+ weeks? At this point, I am really regretting having this surgery done. The headaches are horrible. I really need to know if this is normal, and if so, when I might expect these symptoms to disappear. Thank you!

  24. I had #19 extracted on 8/3 with a bone graft put in for a future implant. I have stitches holding in the membrane and also stictches behind #18. Is it normal for me to have pain in #18 and #17 when biting? I’m not chewing on that side but sometimes my teeth will hit and if I just close my teeth down I feel pain. It’s only been a week and a half but this is just making me a little uneasy.

  25. Hi Dr Amin,

    Almost 7 weeks ago I have done a bone grafting, bone was harvested from my chin.

    My issue now is at the chin area, there are some lumps under the cut line, and especially one is large and painful, the area around that painful lump is swollen. It gets more painful when talking and eating. What is it? I thought after 7 week the area should be in better condition.

    The stitches used were the reabsorbable type.

    I also have a burning sensation in the middle of the lip, since the day of the operation. While receiving surgery I felt as a peg was pressing hard on my lip, maybe the instrument to hold my lip was pressed too tightly?

    Dentist prescribed anti inflammatory for a few days but did nothing, then prescribed antibiotics and also did nothing, now she says to wait more. What is your take?

    1. What you had Is called a block bone graft. Please see the previous posts on the topic that I have written over the years. I have done chin harvesting and only utilize that when absolutely necessary. Your feeling will hopefully return back to normal… Just give it time. Probably 3-6 months before it feels normal again depending on technique and your unique anatomy.

  26. I just got a bone graft done for my lower 2nd molar on my right side. The colagen sheet came off and my dentist said this would likely happen when the stitches came out. However when i look back there or feel it it feels just like a hole with nothing there. I was wondering does this mean the bone graft fell out or do they just not sit that high up.

  27. Hi Dr. Amin, is it best to place implants upon extraction/ bone grafting? Is there a window of days in which implants can be placed after an extraction/ bone grafting, or does it have to be immediate? The reason I ask is that I’m looking at 2 offices that offer different services. One has bone grafting with PRP and the other Zirconia implants. Do you know if these 2 procedures can be scheduled within a few days of each other?


  28. Dr. Amin,

    I had my #18 removed a few years ago and planned to leave it vacant. Three weeks ago I needed to have my #19 extracted and plan to have it replaced with an implant. Since I’m getting an implant for 19, I’m considering having it done for 18 as well. 1) Would you recommend I have 18 done as well (cost isn’t a big issue)? Any possible problems for either doing or not doing it? 2) Can I have an implant for 18 if I never had any grafting done after its extraction? Thanks

  29. Hi Dr. Amin,

    Here’s a picture of my mouth as taken by an orthodontist: https://imgur.com/a/YWIuB1v

    My background story is that my upper canine never came out and so I lost bone in the area, then got implants, but they are small and don’t fit my bite. The implants are shown in the first picture, it’s the tooth in the upper right with the little hole in it and the one above it.

    I want to fix my inclined plane by using braces, and my orthodontist said that first I need to replace my implants and get bone graft in the area. My question is, is this something that is really necessary to fix the plane? I really want to leave my implant alone, and bone graft sounds extremely complicated, and it costs so much!

    Thank you

    1. COMPLEX! You would likely have to remove the implant, then do the braces, then replace the implant. Your case is very unique

  30. I had a synthetic bone graft with implant for central inscisor. The bone graft is growing where it is not suppose to grow bone .. upper part of gum.. below nose and gives me headache and difficulty breathing. What can be done. Thank you

      1. It is now 8 months . Synthetic can take 6 maybe 9 months ?
        What are reasons for failure .. fibrous material ? How does bone grow where it shouldn’t ?
        Can flap and regraft work, I’ve read low success rate.
        Thank you

        1. Synthetic is only good for very small contour defects and not for actually placing the implant right into. Some biphasic calcium products are reasonable as long as the socket walls are intact. Failure is due to lack of integration and creation of actual vital bone. Flapping and re-grafting can work but generally requires a higher level of skill.

  31. Hi there! I had a upper right tooth extracted approximately 12 days ago and bone graft set in place. To my surprise, I also ended up with dry socket which is now being resolved with antibiotic. I’m having a great deal of cold sensitivity to the wound site. Is this normal?

    1. Dry sockets don’t happen on upper teeth 99.999999999999% of the time. You likely got infected. Antibiotics were a good idea. The cold sensitivity is from the other teeth roots that were previously covered by the tooth that got extracted. This almost always goes away on its own.

  32. I had all 4 wisdom teeth our a week ago today, the lower two had bone grafts put in. My right lower is so much more painful and sensitive than the rest (It starts really painful in the morning subsides during the day and is painful again at night). I went to my dentist yesterday and she said they was all healing fine and gave me a syringe to keep the lower right clean (and said that was causing my discomfort). But then today I woke up still in a lot of pain.. Should I be worried that this one looks and feels different from the others or is it too soon to tell?

    1. I do not believe in bone grafting wisdom teeth sockets except in the very extreme situations on older patients. I have done thousands of bone grafts but probably only 2 or 3 around wisdom teeth. I would much rather see you have L PRF placed inside of a socket that a bone graft into a wisdom tooth socket. I also do not agree with using a syringe to keep it clean because he will just rinse the bone right out. Of course I have not seen you before and each circumstance is unique but just based on what you are saying this is my opinion.

      1. Hello Dr. Amin:

        How do I write in my own question to you without hitting reply? I had a block bone graft 4 weeks ago on my lower jaw. I needed to have width and height built on teeth 18 & 19. Gum was taken from my pedicle area not from my palate. Four weeks later I am still oozing blood and swollen a bit and taking Tylenol or Advil for pain. I have experienced a constant ear ache that recently started and a numbing/tingling sensation in my chin at times. I feel I can’t get back to my normal life. The oral surgeon always just says there is no infection and can’t figure out my source of pain. Every time I feel I have a good day, then the next day or two could be back to pain. Pain in early hours of morning around 3-5 am wakes me from sleep. Is this all normal? Thank you. Deborah

  33. Dr. Amin,

    I don’t know if this is the appropriate thread to post this in, but I wanted to pick your brain on what you think about BMS (Burning Mouth Syndrome). I had posted on here before about my oral surgery where I had tooth no. 13 extracted on February 8 of this year and the difficulty I experienced with the area healing. I had started suffering from these very odd tastes in my mouth, which were sometimes salty, sometimes sour, other times bitter – or any combination thereof! I have consulted a plethora of dental professionals, but they were either not taking this seriously or didn’t have any answers for me. I’d love to get your input – as I have since found out, BMS quite often occurs after dental procedures, so I assume you must have some experience with this.

    Thanks very much in advance for your much appreciated reply!

    1. Bull Group Int Rech Sci Stomatol Odontol. 2010 May 21;49(1):19-29.
      Response to topical clonazepam in patients with burning mouth syndrome: a clinical study.
      Rodríguez de Rivera Campillo E1, López-López J, Chimenos-Küstner E.
      Author information
      Burning Mouth Syndrome (BMS) is a difficult disease for patients and clinicians. Moreover, there is not a general consensus on how to treat the disease. The main objective of this paper is to evaluate BMS patients’ response to topical clonazepam treatment. A double blind study was performed. Among a total of 66 patients, 33 were treated with tablets of clonazepam and another 33 were treated with a placebo. Symptoms were evaluated after 1 month and 6 months of treatment and scored on an analogical scale from 0 to 10. Among the 33 patients treated with clonazepam, 23 showed at least a 50% reduction in symptoms after 1 month of treatment. On the contrary, only 4 in the placebo group exhibited significant improvement. After 6 months, significant differences were observed again, as 23 of the 33 patients treated with the drug reported at least a 50% reduction in symptoms, whereas only 2 among those treated with the placebo significantly improved. However, when measured in terms of a complete cure (lack of symptoms), the differences were not significant: 5 drug-treated patients and one belonging to the placebo group were asymptomatic after one month of treatment. In summary, it seems that clonazepam applied topically was effective in treating BMS in a large proportion of patients.

      1. Hello Dr. Amin,

        I had an extraction done of my tooth no 29 exactly 4 weeks ago. Then the surgeon did a bone graft for future implant. I still have pain sometimes not as bad but sometimes excruciating. Had I known it would be this bad, I would not have done the bone graft. I went back to him couple of times, and he says it is part of healing and leave it and will get better. The way the pain is, sometimes in the morning when I wake up it feels just fine, but as I move around and drink coffee, and the day progresses, pain gets worse. Could it be that my muscles are constricting the bone graft causing this pain?

        I appreciate your reply

        1. Something is wrong. This does not make any sense. An updated 3-D scan is indicated and you should do hot and cold the testing on all teeth remaining in the area. Either you have an infection or you have another tooth going bad masking itself in the same quadrant of your mouth.

        2. The same exact thing is happening to me. I am two weeks out extraction and bone graft. Did you get an answer regarding this pain/sensitivity? Mine is good in the morning and also gets worse throughout the day with eat, drinking, working, etc.

    2. I also ended up with BMS after implant surgery. At the same time, I have had a white film on my tongue with which the Dr treated me for oral thrush (she said she didn’t believe it was, but gave me Nystatin to take). The dentist gave me fluconazol and that didn’t help, either. After the titanium abutment cap was removed and the crown placed, the burning went away but the tongue is still white. I also saw a gastro doctor and she said after all the tests I had been through there was nothing she could see except that it had to to with the antibiotics and my history of ibs.

  34. just had a bone graft how long before I can safely go back to physical activity I’m an avid runner? and am scheduled for some events ? 1?2 marathons extra.

  35. Hi Dr. Amin,
    I had an implant removed 15 days ago, and bone graft placed. I had a lot of infected tissue and bone loss. After 10 days, my sutures and membrane were removed and I was told all was healing fine, and that the gum tissue would gradually cover the graft. Is it ok for the graft to be exposed? I have also noticed some pieces of bone in my mouth after the membrane was removed. Thanks for your thoughts.

  36. Hi Dr. Amin,

    Thanks so much for taking the time to answer all these questions!!!

    I was on 10 days clindamycin (started night before surgery) for bone graft prior to implant. 7 days after surgery the site got infected. Metronidazole was added for 14 days and clindamycin was extended for another 7 days. After 21 days, things feel normal, except it is painful if I press on the gum of the tooth near the implant site. Is this normal?

    Thank you very much for answering!

    The performed procedure was as follow: “
    … The procedure I performed is called a tunnel bone graft with a remote access. The incision was made between the two teeth and the gum tissue in front of the graft site with a small incision vertically on the outside gum tissue in front of the front tooth. This incision was closed with Teflon sutures which have been since removed. Once I had created the tunnel for the graft by releasing the soft (gum) tissue from the bone at the site I then decorticated (made the bone bleed) by scraping and making small holes in the bone. I then placed particulate graft material made of Hydroxyapatite (calcium) and Collagen (gelatin) mixed with your platelets into the tunnel before suturing it closed. This is a standard bone graft…

    Thanks again!!!

  37. I had a bone graft and sinus/nasal lift on 20 March 2018. During the procedure my dentist also placed two (2) posts for implants. My face on side of surgery was swollen for 4 days. I took the antibiotics & medication for pain, but it was still very painful and felt extreme discomfort. I am now healing and will be returning for implants in about 6 to 9 months. I realize every mouth, gums & teeth are different, but in general does a dentist place the posts at the same time of bone grafting and sinus lift procedure?

    1. Placement of the implants at the same time of sinus lift or nasal lift is common. Especially the nasal lift. I hope you were sedated for this procedure and received intravenous steroid. This would’ve helped tremendously with healing. Most of my patients that have this procedure perform only take a combination of Tylenol and ibuprofen. I don’t even prescribe any narcotics such as Vicodin or Norco for this procedure in my office. I hope you get better soon. Pain is no fun. ;-(

  38. Dear Dr. Ramsey
    My upper molar was pulled and bone graft and collagen was put in place on 4/9/18 (today 4/12/18).
    I have seen 3 tiny sand like particle (definitely bone graft) in mouth so far.
    I don’t have to worry about it?
    If I still see them coming out after a week, should I contact oral surgeon who performed?
    Thank you

  39. Dear Dr. Amin,

    Can the sutures be taken out sooner than 2 weeks after the bone graft (#13) and sinus lift (#14 and 15 are missing)?
    Thank you very much! 🙂

  40. I had a bone graft done on my lower jaw (molar tooth extraction). My stitches came out after about a week. I can see the bone graft and I’m wondering if the gums will actually keep healing over the top? It’s still socket like. No pain or redness or swelling. I don’t have any issues with any bone particles falling out either. Just concerned if it’s healing right?

    1. as long as you are healthy, the body will “repair” everything. That being said the “regeneration” of the area may be compromised. The bone may not be as plentiful and may be soft at re-entry.

      1. I had my front tooth extracted 2 months ago and just had a bone graft and implant done. I had extra gum put in and seem to have gum flap on roof of my mouth. How long is the healing time for something like this and does the gum flap on roof of my mouth expand over time?

  41. Hi, I commented on here a few days ago but it’s not showing up here. My issue is that my gums are still quite swollen and uncomfortable two weeks after a tooth removal and bone graft. I went for a recheck on Monday – 11 days post surgery – and the surgeon removed the stitches (I had to have incisions into my bums to create a flap and for her to be able to access the tooth and there was nothing to grip onto after the faulty crown came off). I thought I’d be getting better quickly after suture removal, and initially it did feel more comfortable, but the gums above where the tooth was are still swollen and feel puffy, and it’s driving me crazy! I’m also concerned that this might interfere with proper healing of the bone graft – or could the bone graft cause this issue? She said it looked like it was healing and closing over ok….Can you give me any advice on what I could do? Any other medication? I ws initially taking a week of Amoxicillin and Ibuprofen or Acetaminophen several times a day. I’m still occasionally taking an NSAID for its anti-inflammatory properties (even though it doesn’t seem to be doing much?). Thanks for your help – your blog is great!!

    1. You are likely infected. Continue on a second round of antibiotics. Consider switching the type or adding a second type of antibiotic. Please use the search bar to find the post on antibiotics. (Can’t send you a link from my phone..sorry)

      1. I went for another recheck with my oral surgeon yesterday (3.5 weeks post-op) and she claims it is all looking good – healing well and good granulation etc. However, I have had a weird sour-salty taste in my mouth for a few days now; the sourness started after using the chlorhexidine rinse for several days, that seems to have really messed up the inside of my mouth….and the saltiness? I don’t know if it’s coming from the extraction site (surgeon claims not possible because healed over…) or a lowered PH level in my mouth? I emailed her again, asking whether there could be a low-grade infection after all and whether I should take another round of antibiotics, but she says she doesn’t want me to because she didn’t see any indication of infection yesterday and she thinks the antibiotics would do more harm than good in the absence of infection..I am not so sure, and I’ve also emailed my regular dentist about the situation but she has’t gotten back to me yet….I just don’t know what to do anymore. I think and worry about this non-stop!!

  42. You have a very interesting and informative blog!

    Approximately 10 weeks ago I had an upper right molar extracted to access and remove a 2cm growth that was in my jaw/palette/sinus floor. After the growth was removed a cadaver bone graft was put in place. Post procedure healing of tissues seems to be normal, and the biopsy of the growth came back negative. However since that time, I have been troubled by disorienting headaches, sinus, cheek bone, nasal bone aching and pain, jaw pain, and neck pain. Approximately one month after the procedure a sinus infection was treated with antibiotics. While the site of the extraction and implant seem to be normal my health has not been the same since the procedure, and we’re mystified why my health has changed so much, especially after many other tests come back negative (e.g., ECG, diabetes, CT scans). Is there any chance that my body might be reacting to the graft? Is there something else we might investigate? With thanks…

    1. Another round of antibiotics adding flagyl may help. The dead center of the large graft may be dead while the outskirts are coming to life.
      2cm is a large graft!

    2. Hi Wayne,

      I’m having similar issues myself. Severe neck pain started about 10 days post procedure (my graft and tooth pulled was lower left), along with a swimming feeling in my head, extreme exhaustion, and just general terribly sick feeling. Have you been able to figure out what it was or what cured it? Thank you for your help.

  43. Hi there. First off, I read a lot of your replies and cannot thank you enough for answering all of them!2 wow! You’re awesome
    I had an upper tooth (crown) extraction and bone graft placed on Thursday, Feb 8th (today is feb 17th). I had no pain or issues until Saturday. Then it was throbbing with every step/movement and just painful. Kept me in bed most of Saturday and Sunday. I take care of 2 babies Monday- Friday so I was up as usual all week. The stitches started falling out on sat. Came out completely Wednesday. Pain is managed only by 4 Motrin q6hrs. Script pain meds last 3.5 hrs tops. I am having pain on the site, on my cheek and now my lower jaw as well. Idk if I have a fever because I try to stay on meds. Bone fragments fall out often.
    Is this normal to be in pain this long? I tried to use the clove gel but it hurts worse. What can I do in the meantime? Sleeping with ice on my face helps me get some rest.
    Thank you!

    1. Also added that I took care of the babies on Friday after my extraction. I was told there were no limitations for returning back to adl’s.

    2. Not normal. Are you on an antibiotic? If not you need to be. Flu season isn’t helping anyone either. Even yours truly has a mild virus which can greatly modify the healing process.
      You need to see your DDS for a follow up ASAP.

      1. Thank you for the response. I went to the surgeon on Monday and he said I might have a sinus infection? I’m not having any symptoms of one but ok. I’m on antibiotics now and the pain is getting better!

  44. Dear Dr. Amin,

    I had my top right molar removed and bone graft with collagen plug put in on Friday. As of Monday I already had stiches coming loose and hanging out. Also from what I see in my mouth the collagen plug has almost completely disappeared leaving quite the indent where the tooth was. Is this normal?

    Lastly how long am I supposed to have bone fragments from graft falling out as I still get some when I eat and brush.


  45. Hi Dr. Ramsey,

    My mother had a bone grafting on the lower jaw. There were 2 different operations about one month apart, one on each side, one was done in order to have 3 implants fitted and the other for 2.
    She took antibiotics prescribed by the dentist. She had no infection, no pain, which tells me that it healed properly but after about 2 months her face (both cheeks) is still swollen on both sides. Can you please let me know if it is normal and if there is anything that can be done?

    Thanks in advance for your kind reply,

    1. She needs to be seen by her dentist. This would not be considered normal unless the purpose was to bulk things out quite a bit. He would have to do a very large bone graft to change somebody’s facial appearance. The fact that she has no pain and no infection per the dentist is a very good sign that things are okay.

  46. Hi Dr. Amin,

    I went to an Oral Surgeon around the middle of November 2017 to have lower left molar extracted and bone graft put in. After 2 and half months later, during routine X-ray by my regular dentist, he felt the bone density where the graft was placed, is not as dense as it should. He suggested a second opinion by another periodontist to evaluate the bone graft density. Is 2.5 months to soon to judge the density of the bone graft?

    1. Yes this is too soon to judge. Also depends on the type of material that was placed. Some of the very best materials do not mineralize an turn white on x-ray until 6 months to a year have past while others are white and dense looking from day one. The appearance on x-ray is a small part of the story. Your dentist may not be well-informed on differences in material density and mineralization over time. I would not bother with any second opinions at this time. Allow the graft to heal for a minimum of 4-6 months before evaluation for the implant. Don’t be in a rush to put the implant in!

    2. Dr. Amin,
      What will then be the best method to determine whether the bone is dense enough to place an implant after 6 months?

  47. I had my bottom right molar extracted, bone graft, guided tissue regeneration, and the implant put in on the same day. After my sutures were taken out 2 weeks later, I did not have pain anymore (I had slight throbbing with sutures in).

    Out of the blue, a month after I had the sutures out, I started feeling some discomfort in the lower right area – sometimes along the jawline, sometimes below the ear where my jaw curves. I wouldn’t call it pain – more of a heavy, tight feeling. The most painful it ever gets is a very dull pang.

    I went back to my dentist and he examined me and performed some nerve tests. He also took an xray. Everything looked perfect to him – no infection or anything.

    Any ideas what this could be?

      1. My dentist is hesitant to give me antibiotics because the surgical site does not look infected nor does the infection show up on the xray.

        Can there still be an infection without it showing up on the xray?

          1. My dentist finally gave me antibiotics (Clindamycin 300mg). I felt better the first 3 days on them. On the 4th day, I started feeling a bit of discomfort again but not as bad as before. It’s not a constant tightness anymore but maybe an hour or 2 of tightness/heaviness and random pangs of slight pain. I have 1.5 more days of antibiotics to go.

            I also noticed that the gum area around the buried implant right against my next molar is a bit tender/itchy when I brush my teeth.

            I’ll be requesting an appt with my dentist next week but I’m afraid that she will keep insisting that nothing is wrong. Any ideas what to do next?

  48. Dr Amin,

    I read another post where you say that infection and ear pain post bone grafting are issues and my dentist does not know what to to do about them. My dentist tried to “fix” my infected that had been perfect for 15 years. That did not work and he found “odd tissue” when he went in to pull the implant even though he said that 100 dentists would find my X-rays perfect.

    Today I am a week out of the new bone grafting and my jaw throbs up to my ear. I have taken 4 rounds of antibiotics, am a very healthy ~ just turned 50 yr old female who is in health and wellness.

    Stuck on how to get rid of this infection and heal up my mouth so I can get rid of the head and jaw ache of the past 6 weeks. Do you think that cold laser would be advantageous for this?

    Thank you for your thoughts!

      1. Hi Dr Amen, sorry to be unclear. I had an implant for 15 yrs. it got infected, he tried laser, tissue and bone grafting, that failed. We pulled it a month later. More grafting, that failed.
        Right now I am wondering if we are not hitting the right kind of bacteria and if the bad bacteria in this 15 yr perfect implant could have come from a tick that I found on me and possible bite where it started to lodge but I interrupted it with the hair dryer. I ask that because that was the first time I felt the pain in tooth #30 was 4 days after I found the tick in the state of Maine.

        I am 6 wks into infections, 4 ends of anti-biotics and 4 surgeries. Any thoughts?

        Thank you, I appreciate you and you are wonderful in your support!

        1. I think just coincidental but not related. An implant can go from healthy to failing much faster than a tooth. This condition known as peri-implantitis can be aggressive at times. Your better off removing it than trying to salvage. Sometimes salvage is possible if diagnosis and treatment plan is perfect.

  49. Dear Dr. Amin,

    I just saw this comment (below) and I had a similar problem but I also have a mettalic taste in the mouth. My bone graft didnt close well so now I have bits of the material coming out and the mettalic taste started today. Should I be worried? Is the mettalic taste related to the fact that the bone graft is coming out?

    Many thanks in advance!!

    Julia Rodrigues

    “Dear Dr. Amin

    I just had 2 implant and bone graft at the same time on my upper front tooth, that was 1 week ago but ont the 5th day i had to see my dentist coz i saw the granules of the bone graft, he said the stitches was loose so he had to stiitch it again gosh that was really painful that the surgery he did coz it was swollen and sore when he stitch again, but now is my 8th day and still i can still taste salty and taste the bits and pieces of the bone graft and still expose. Is this normal or what is a bad sign of failure? I have pain killers and taking clindamycin though it’s not painful anymore just a lil bit of aftershocks. I need ur advice please,
    Thanks and God bless”

      1. my graft was done in december 2016. implant then done may 2017. i still have metallic taste! and gum is whie above graft. is this a priblem?

  50. Hello,

    I had a bone graft and implant placed 2 weeks ago on front tooth 12 so far there is no pain discomfort and everything seems fine. is it possible for me to get back to my workout routine?
    i do weight lifting.

        1. I would say wait about 7 to 10 days if your body tells you it is OK to do it better to ask your doctor.

          Not sure if you are mentioning needs a lift or sinus lift. Those are two different things.

  51. 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.

    1. 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.

  52. 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,

  53. 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?

  54. 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!

    1. 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!

    2. 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.

    3. I have the same issue with my bone graft. I have also seen my dentist and have had an xray of the area with no noticeable problems. No one can tell me why this is happening. I am getting very tired of this. Pain will last for a week or more sometimes. I had my bone graft almost 2 years ago. I agree, I will never have an implant again.

      1. something seems completely strange. I have done these types of procedures thousands upon thousands of time and have not encountered this. I have seen about every complication known to man. I’m guessing you have some sort of loose particles inside of the graft and the bone is not “alive” in one particular spot. I would suggest that the gum is opened and any dead or loose bone is removed.. Only by doing a surgical flap and seeing it in real will you ever get any sort of cancer. X-rays alone will not help

      2. something seems completely strange. I have done these types of procedures thousands upon thousands of time and have not encountered this. I have seen about every complication known to man. I’m guessing you have some sort of loose particles inside of the graft and the bone is not “alive” in one particular spot. I would suggest that the gum is opened and any dead or loose bone is removed.. Only by doing a surgical flap and seeing it in real will you ever get any sort of cancer. X-rays alone will not help.

    4. I had the same thing happen to me.

      For almost a year I had on and off pain in my graft site.(lower left) After being told numerous times that nothing was wrong and xrays looked good, I went for a second opinion. I had a cone beam scan and it showed that the graft never took. Some of the bone graft was encapsulated and other parts were gone leaving defects. It was soft fibrous tissue, not bone.

      I just had the bone graft taken out and a new one put in.

      Get a cone beam scan and make sure it is read correctly. (Very important)

  55. 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?

    1. 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.

  56. 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?

  57. 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!

  58. 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

    1. 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.

  59. 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.

    1. 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.

  60. 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?

  61. 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.

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

  62. 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.

  63. 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?

  64. 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.

    1. 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.

  65. 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?

    1. 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.

  66. 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!

    1. 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.

    2. 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.,

  67. 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?

    1. 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.

      1. I had #30 extraction and #28 and #30 synthetic bone grafts. Is one year too long to wait to have implants. Surgeon office just said “call when you’re ready”.

        1. No…that is fine…but if you keep waiting it may shrink depending on the exact materials that were used. Each material has a different shrinkage rate.

  68. 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.

  69. 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

    1. 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.

  70. 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.

    1. 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.

  71. 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?

    1. 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!

  72. 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.


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

  73. 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?

    1. 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!

      1. Hello Dr.Amin,
        I have somewhat of a similar question. I got my implants (the screws) in with a bone graft being done 9 days ago. The facial bruising and swelling has gone down by now and i had little to no pain after the surgery. However, the roof of my mouth behind the two implant sites (they are the two teeth next to my two front teeth on both sides) is still swollen i guess you could say… there are lumps on the roof of my mouth that are preventing me from putting my flipper in that ive had for years. The dentist and the oral surgeon arent really giving me any options for covering up the spaces and i cant go four months without teeth. (They never said i could have a new flipper made up, which would be an ideal situation) However the surgeon did say he would take the stitches out in 2 weeks, but its been close enough to 2 weeks and this bumpy pallette isnt showing signs of progression in its heaing process like the rest of my mouth did. I’m worried that these lumps on the roof of my mouth will not go away and i have to work in 2 1/2 days no matter what. I dont want to have to go without teeth but i dont think i have any other options. Can you give any advice to help my situation?

        1. hmmm…Seems strange that all of this wasn’t discussed in advance. All you have to do hopefully is just have the flipper adjusted. It is very important that it clears the newly placed implants, bone graft and swollen gums. If it applies pressure it can cause failure of everything you have had done. Sometimes they cannot be adjusted to thin or they will break. An excellent alternative in these situations is and Essix temporary bridge. It basically looks like a clear orthodontic Invisalign retainer with teeth in the area that are missing. Hopefully this helps you get this resolved quickly so that you can head back to work with dignity.

  74. 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?

    1. 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. 🙂

      1. 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-

        1. 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.

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

  75. 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.

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

  76. 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.

  77. 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.

      1. 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?

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

  78. 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.

  79. 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?

    1. 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.

  80. 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.

    1. 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.

  81. 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!

    1. 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.

  82. 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!

    1. 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

  83. 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!

  84. 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?

  85. 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.

    1. 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

    2. 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

  86. 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!

  87. 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.

    1. 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

  88. 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

    1. 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.

  89. 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?

    1. 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.

  90. 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….

    1. 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

  91. 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

  92. 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.

  93. 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.

    1. 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.

  94. 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. 🙂

  95. 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?

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

  96. 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 ?

  97. 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.

    1. 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.

  98. 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..

    1. 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.

  99. 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

    1. 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.

  100. 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!

    1. 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!!!!

  101. 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?

  102. 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~

    1. 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

  103. 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.

    1. 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

      1. 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!

        1. 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.

  104. 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?

    1. 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

  105. 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!

    1. 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

  106. 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!

    1. 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

      1. 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?)

        1. 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

  107. 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??

    1. 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

  108. 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.?

    1. 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.

  109. 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.

    1. 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

  110. 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 ?

    1. 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

  111. 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?

  112. 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!

    1. 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

  113. 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

    1. 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.

  114. 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!

    1. 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.

  115. 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.

  116. 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)

  117. 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?

    1. 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

  118. 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

    1. 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.

  119. 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?

    1. 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.

  120. 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.

    1. 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.

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

  121. 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?

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

  122. 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

    1. 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.

  123. 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. ?

    1. 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.

  124. 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?

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

  125. 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 ?

    1. 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.

  126. 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.

    1. 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.

  127. 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.

  128. 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?

  129. 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?

    1. 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

  130. 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?

    1. 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

  131. 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.

    1. 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.

  132. 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

  133. 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!

    1. 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

    2. 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…

  134. 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?

  135. 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

  136. 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.

  137. 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

    1. 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

  138. 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”.

    1. 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

  139. 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?

    1. 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

  140. 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

    1. 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

  141. 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..

  142. 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?

    1. 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.

  143. 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?

      1. 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.

  144. 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

    1. 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.

    2. 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

  145. 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.

  146. 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?

    1. 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

  147. 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?

  148. 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.

    1. 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..

  149. 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.

    1. 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.

      1. 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?

        1. 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

  150. 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?

    1. 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

  151. 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.

    1. 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.


      Ramsey Amin DDS

  152. 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.

    1. 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.

      Ramsey Amin DDS

  153. 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 ?

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

  154. 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!

    1. 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.

      Ramsey Amin DDS

  155. 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!

    1. 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


      Ramsey Amin DDS

    1. 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!

  156. 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.

  157. 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.

  158. 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?

      1. Hello Doctor,
        I’ve been reading your site and watching your videos throughout the process of my #9 tooth that I had to have extracted (eating chicken bone broke tooth). My dentist is a periodontist since I had gum recession. I am a healthy 59 year old.

        1) Extraction 19 Dec 2017, bone graft done, ridge preservation, gum generation

        2) CT cone scan 24 April 2018, 4 months since bone graft, doc says I didn’t generate enough bone he says I have 5mm and he wants 6mm. He said he wants to place the implant now and he’ll do more bone graft at the time of placing the implant. He said after 4 months the bone is not going to generate any more.

        But I see you say wait 6 months.

        I have scheduled my appointment for 18 June 2018 which will be exactly 6 months.

        Should I wait another 2 months and pay for another CT cone scan?


        Should I just go in at the 6th month level and he will see at that time if there’s enough?

        I don’t want to pay for a bone scan if I don’t need one and if 4 months is not enough time then that could be the case, and by 6th month at time of implant would he be able to tell if I have enough bone? I’m assuming he is not going to be doing another CT cone scan.

        Thank you.

        I hope you are still answering this post, it’s 2018 now!

        1. Still answering questions..all these years later 😉

          The bone width is not going to change any more than it already is. The only thing that will happen in time is that the bone will mature more and become more dense. If the bone maturity looks okay at 4 months and it was a relatively simple socket preservation graft then it is likely fine to proceed. It never hurts to wait a bit longer but you have been very specific with your description and additional width will not be gained by waiting.

  159. 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.

    1. 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

  160. 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?

    1. 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.

      1. 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.

  161. 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?

    1. 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.

  162. 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?

    1. 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.

  163. 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

  164. 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

    1. 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


  165. 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 ??

    1. 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

  166. 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.

    1. 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

  167. 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

  168. 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

    1. 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

      1. 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,


  169. 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

    1. 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


      Dr. Amin

  170. 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?

    1. 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

  171. 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

    1. 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

  172. 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?

    1. 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??

  173. 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?

  174. 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?

    1. 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

  175. 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.

    1. 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

  176. 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?

  177. 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.

    1. 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??

  178. 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.

    1. 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

  179. 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?

    1. 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

  180. 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.

  181. 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?

    1. 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.

  182. 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…..

    1. 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.

      1. 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?

        1. 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.

  183. 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.

    1. 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.


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

  184. 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

    1. 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

  185. 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.


  186. 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?

    1. 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

  187. 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.

    1. 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

  188. 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.


    1. 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.


      Ramsey Amin DDS

  189. 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,


    1. 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

  190. 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?

    1. 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

  191. 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,

    1. 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

      1. 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!

  192. 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?

  193. 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.

    1. 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

      1. 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.

  194. 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?

  195. 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.

    1. 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?


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

  196. 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….

  197. 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 !!

    1. 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

  198. 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…???

  199. 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.

    1. 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

  200. 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

    1. 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

  201. 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

    1. 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 T