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.

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

  1. Hello Dr. I had a bone graft after my top two left 1st and 2nd molars were extracted. As soon as the anaesthetic wore off I felt excruciating pain the in adjacent tooth to the bone graft. We did a round of antibiotics and I’m on pain meds. The pain is no longer extreme but the tooth feels weird. Like it’s not my tooth. Almost like it’s bruised or squeezed. I’ve had a check up on the bone graft and the dentist said it is healing slowly. Will this feeling in that tooth go away? Any suggestions as to why I might have this feeling?

    Reply
    • It sounds like you’re experiencing some discomfort and unusual sensations in the tooth adjacent to where you had your bone graft. One possibility to consider is that this could be due to fremitus. Fremitus is a vibration or movement of a tooth when it’s in function, such as when you’re biting or chewing. This can sometimes occur if there’s been a change in your bite, especially following the extraction of other teeth.

      Since you’ve had extractions and a bone graft, it’s possible that the alignment of your bite has been altered, leading to increased stress on the adjacent tooth. This can manifest as the sensations of bruising, squeezing, or just feeling “weird,” as you described.

      I would recommend going back to your dentist to have your bite checked. They can evaluate if there’s any undue pressure on the tooth in question and whether any adjustments need to be made to your bite to alleviate this pressure. Adjusting the bite can often alleviate symptoms like the ones you’re experiencing.

      Reply
  2. Hello! I had a bone graft on the upper left after having molar 1 and 2 removed. This was 3 weeks ago. The probelm is the small tooth next molar one has been on so much pain since having the graft. It doesn’t feel like my tooth and hurts under pressure. I’ve been back to the dentist and she said it’s healing. She doesn’t know why the tooth next to the bone graft feels this way. Any suggestions?

    Reply
    • It sounds like you’re experiencing some discomfort and unusual sensations in the tooth adjacent to where you had your bone graft. One possibility to consider is that this could be due to fremitus. Fremitus is a vibration or movement of a tooth when it’s in function, such as when you’re biting or chewing. This can sometimes occur if there’s been a change in your bite, especially following the extraction of other teeth.

      Since you’ve had extractions and a bone graft, it’s possible that the alignment of your bite has been altered, leading to increased stress on the adjacent tooth. This can manifest as the sensations of bruising, squeezing, or just feeling “weird,” as you described.

      I would recommend going back to your dentist to have your bite checked. They can evaluate if there’s any undue pressure on the tooth in question and whether any adjustments need to be made to your bite to alleviate this pressure. Adjusting the bite can often alleviate symptoms like the ones you’re experiencing.

      Reply
  3. Hey dr I really hope you see this! I had an extraction on #3 molar 2 weeks ago. I just finished amoxicillin and metronidazole. 1 week ago I did accidentally floss it and i wonder if I pushed it in or something but I don’t know of that’s related. I am having intense pressure and pain on the extraction site where the bone graft is. It feels like something is being pressed into my gums. The dentist said it was healing well and looks good and to wait it out but the pain is unbearable. Could having the bone graft removed help? Any advice is greatly appreciated!

    Reply
  4. Hi Dr. I hope you still read these years after.

    I had a failed implant (after more than a decade of failed periimplantitis treatment, but no periodontal disease otherwise) removed almost 4 weeks ago from tooth site #9.
    The doctor cleaned the area and did a particulate bone graft, not sure which kind. I can see from the X-rays that I had most likely vertical loss, especially once the implant was removed.

    After a week the doctor took off my stitches (earlier that she’d plan to) because it was very swollen and it seemed infected (I didn’t have bad taste or internal pain, just pain at the stitches site) and that day a low of the swelling went down, it seems as if she drained some blood from there, and she switched me from amoxicillin (which I’d been on for a week starting the day of the surgery) to amoxicillin/clav for 2 weeks.

    That very day I saw her I found like a pinch of the bone graft on my flipper tooth in the evening, I think because she touched it to drain it, and then it decreased to 3-4 particles here and day during week 2.

    It is now almost week 4 and even though the gum looks pretty healed, there is still a tiny hole in that area, like 1-2 millimeters wide, but some particles still come out here and there.
    I texted my doctor and she said that while that little hole is still there that will continue to happen. (particulates falling out)

    My questions are: (and I do apologize that I have so many)

    1-is it normal for the gum to not be completely closed after 4 weeks? And will it close??

    2- how long does it take for the particulate bone to consolidate with the blood clots up there? I understand it take months to turn into actual bone, but when does it stop being loose particles? My concern is non of it has consolidated and that’s why it keeps falling out.

    3-My flipper has bit of fake gum on the top and sides, kind of making an arch on the two surrounding teeth. Could that bit be putting some pressure on the front/top of the gum and be ruining my graft? I don’t feel pressure or pain from it, but I know it rubs the area.

    Reply
    • YES I am still active on this post in 2023! It is still very relevant!❤️😊

      1-is it normal for the gum to not be completely closed after 4 weeks? And will it close??

      Yes this can be very normal and not to worry about if it is a standard socket bone preservation graft

      2- how long does it take for the particulate bone to consolidate with the blood clots up there? I understand it take months to turn into actual bone, but when does it stop being loose particles? My concern is non of it has consolidated and that’s why it keeps falling out.

      Loose particles may happen up to 2-3 months. It takes 4-6 months to actually make it into bone. Do not worry about the stuff on the surface. What is happening under the gum tissue is most important.

      3-My flipper has bit of fake gum on the top and sides, kind of making an arch on the two surrounding teeth. Could that bit be putting some pressure on the front/top of the gum and be ruining my graft? I don’t feel pressure or pain from it, but I know it rubs the area.

      As you probably already know I hate using flippers. I never use them. I would suggest an Essex type of retainer. Any sort of pressure or movement definitely delays and compromises healing.

      Reply
      • Thank you SO MUCH for responding!!

        What you said gave me peace of mind. It’s actually been a month since I wrote you and haven’t felt any more bone particles. The tiny hole was still open a couple of weeks ago but it does seem to be improving….The doctor also did an X-ray a couple of weeks ago (5-6 weeks after surgery) and the bone graft was there. She did mention she will have to do another bone graft before attempting to put an implant. It bummed me out because that extends the time without a permanent solution…

        Like you suggested, I got an essix retainer with a tooth and it feels comfortable for now. I hope it still fits/works after the second bone graft, which she says she will do by opening in the front/top of gum and not on the bottom/hole like last time.

        You can see the two X-rays here (https://tinyurl.com/Kmipics), as well as the gum if you are curious/interested. One is from when I still had the failed implant there, and the other is a month or so after the implant removal and bone graft surgery. The implants are 13 years old and were done back when I live in Cuba.

        Reply
  5. I had a block bone allograft placed on Feb 7, 2023. It does not seem to be healing quickly, and healing even seems to have stalled. There is no pain, no swelling, no signs of infection but the gum does not seem to be growing over the graft very quickly. I still have some of the stitches in place. The surgeon yesterday was very quick to say it looks like it is being rejected by my immune system and will most likely need to be removed. He is giving it 2 more weeks to see if there are any positive changes. Is there anything I can do to help this heal? I think we should give it more time. As long as it’s not infected, wouldn’t my body keep healing? What are the criteria for determining if this is truly being rejected? And, if my body does reject it, what is the next step in preserving my teeth? I had another implant placed on the opposite side that had a bone graft at the time of healing and it healed slowly but 4 months was strong enough for the implant, done by the same surgeon. Thank you for your time.

    Reply
  6. Hi there! I have gotten several treatment plans for myself in regards to implants. I’ve had several extractions years ago and no implants. It’s so expensive! Due to this, my bone has actually grown. So I need bone removed in order to make room for implants. Is the healing process and timeframe the same for removing bone? Most of my back teeth are gone. Should I just remove the rest and get all on 4 or 5? I’m only 32.. Thanks in advance!! ❤️

    Reply
    • Because of your young age you really want to see somebody who is a real expert at this because dental implants are not permanent! The process of removing bone sometimes is called bone leveling. It can often be avoided in the young patient and and Fp1 bridge can be made which would feel and look the most like your original teeth but can be a bit more costly. My best advice is to do you are due diligence and see the best person you possibly can with the most experience!

      Reply
  7. Hi Doctor!

    I had a tooth extraction and bone graft on my lower back molar about 4 weeks ago. It’s been an up and down recovery. Couple days of feeling ok, and a couple days of pain/discomfort.

    Last week seemed to be a bit of a turning point I had a painful couple of days last Sunday and Monday but then it subsided greatly and throughout the week I began to notice little white granules in the socket. Last couple days I’ve felt almost back to normal with some discomfort here and there (like an itching, tight pulling sensation)

    I went back to see my OMS several times and he said all is healing fine, no infection, and that it takes time to heal. 6-8 weeks.

    What do you think?

    Reply
  8. Dear Dr. Amin

    I had tooth #4 removed and had a bone graft in preparation for an implant. How long do I have to wait for the graft to heal before I can wear a flipper? I really don’t like the gap in my teeth, and I would like a temporary flipper before my implant. Thank you kindly.

    Reply
  9. I had #30 tooth removed due to abscess 7 weeks ago. A week later they had to drain the infection again. The infection had been there a long time according to the Endodontist and there was bone loss. Bone graft was done at the same time of tooth removal using cadaver bone.
    My gum where the tooth was removed is sticking out further than the left side and there feels to be a knot in my jawbone line. It often feels as if something sharp is poking my gum and it always sore and hurts. Sometimes I get shooting pains. It is not really comfortable and feels like something is in there that does not belong. Is this pain normal and is my gum going to go down and feel normal again? I keep being told that I am a slow healer even though I paid extra for plasma to be used.

    Reply
      • Hi, I wish there was a response. I am having a similar situation although I don’t believe I had an infection. I had internal resorption on tooth #23 and #26 in 2003. My dentist did a root canal and crown to save the teeth. A few years later #23 failed and I went to a periodontist for the tooth removal and bone graph. No problems. In 2018 #26 the post broke. Same dentist said tooth was ok and replaced post and crown. About a month ago I started feeling some pain in #26. Went to same dentist who said resorption was progressing and tooth #26 needed to come out. He polished all four teeth #23 crown, #24, #25, #26 crown because he said I was biting too hard on the front lower teeth. I have some bone loss there. After the adjustment my whole bite felt off and all pressure went to my canines. It was very uncomfortable. The dentist insisted I had TMJ even though I have no pain in jaw or clicking. But because he said I grind my teeth I have TMJ. After the adjustment my mouth has not felt the same. Painful and off. That week I scheduled to have the tooth extracted and a bone graph. The dentist removed the tooth and did an extensive bone graph (even though I though I was getting socket seal surgery). I had stitches for 2 weeks and he removed them. Since the surgery I have been in pain. It has been 4 weeks. I have a short vestibule he says and I feel pulling when I talk, eat or smile. It also feels like something is in the vestibule area, especially when I smile or laugh. I try to limit this. Some days I am okay but not 100 percent and other times I will have a radiating pain and then a sharp pain in my head. Last week at night it was killing me. I have been running back and forth to the dentist because I have been worried about an infection or that something isn’t right. He says it’s healing and I am sensitive. I went to the periodontist 2 times to see if it was healing okay and he says it looks ok. Xrays were done and the dentist said the bone looks ok and the site is healed. He said whatever pain I am feeling is not from the surgery. Although when I went a few days ago he said he could have bruised a nerve. And to take Advil. He said this will heal. I’m still very worried about what is going on because I don’t think I should be feeling these weird pains and sensations. I am feeling pain right at the moment. What should I do?

        Reply
        • I am sorry are going through such a hard time Tara. I would give it at least 6-8 weeks for a to stabilize. You might fall on the other end of the bell curve and just be healing very slow. Despite which her x-rays look like I be willing to bet you have some low-grade infection in the bone. I am hoping that you had antibiotics a few times to rule out infection?

          Reply
  10. I had a dental implant for the first time. It wiggled from day one when I brushed. The screw has sheared off ant the bottom and they were unable to retrieve it. The dentist extracted he implant and did a bone graft. I’m still in terrible throbbing pain, my neck is bothering me on that side. I keep feeling little glandular things on occasion in my mouth. The dentist removed the stitches today and when I removed the gauze I felt a loose flap of skin and think I see the bone graft but not sure. I feel like I have infection because the pain is relentless. What is your opinion?

    Reply
  11. Hello Dr. Amin,
    I had my bone graft for my upper jaw, front right tooth 3 weeks ago. The swelling has gone away, but looks like my upper right lip still looks thicker than normal and I have uneven smile now; my upper lip seems to move to the right when I smiled. Is it normal and will go away soon?

    Thank you,
    Kristin

    Reply
  12. Hi Doctor,

    First off thank you for your time. I had a extraction and bone graft done about 6 weeks ago. The site seems to look ok but towards the middle of the site bone graft material can still be seen a bit. Is this normal for the gums to not have completely covered the material 6 weeks later.

    Reply
      • Hi Dr Amin

        I had bone grating done on my Upper right hand side Molars. I am preparing to have a bridge secured there. I can see three stitches on the outside. I have been using Motrin for pain and taking antibiotics. Its now day 9 and I am in terrible pain, I am going to request a stronger pain med but I don’t want to take these for more than a few days, is it normal to feel this level of throbbing, it extends up to my ear. I am losing sleep and the last two days have been the hardest. I have not been able to attend the gym or yoga.

        Reply
        • No, I don’t smoke or have diabetes. I’m taking Amoxicillin. I had a check up two days ago but I am spitting green and yellow substance in the morning up to today. The smell and taste is terrible. I am convinced the antibiotics have not worked and I have an infection. I just requested a different antibiotic. I was told on the checkup that pain for the small bone graft I had done will be most uncomfortable from day 7 to 10 as it’s in the process of healing. Well it’s day 10 and I had to go and see my GP to request strong pain meds which I don’t want to take as they make me sick. But this seems abnormal. The strong pain meds have not helped so I am not even going to continue with them. Surely it must be an aggressive infection. My bite was off, they drilled it for a bit. When they cleaned it with saline I smelled a terrible smell coming from my mouth and I apologised to the dentist it was so awful. They said nothing, just that I continue with Advil and this is normal. Should I request an xray at this point? Or a steroid? I take my last Amoxycillin tablet tonight and the course is over. Also they asked me to come and do a full cleaning on my mouth in five days. But I am in so much pain that I don’t want to add to it. They told me it will help with healing. 🙁 Thankyou

          Reply
          • Unless you have undiagnosed periodontal disease I don’t think the cleaning is going to do anything.

            If possible have the dentist add on metronidazole and or switch to a cephalosporin. The area can also be swabbed and be tested. We called this culturing to see which antibiotics are most effective.

            Generally speaking by day 10 my patients have zero pain. Something is definitely off here.

            Keep me posted and I hope you get better 🙏

            This will pass!

          • Hello Heidi
            I have just read your comment and am also struggling with pain post extraction. Did your pain cease or are you still experiencing it?

  13. Hi! I had a tooth extracted about 4 days ago at the top, it was a baby tooth and the adult tooth never came down so they removed the baby tooth and the adult tooth. The adult tooth was literally under my nose. Bone graft was placed there and the swelling is going down but it feels like the bone graft is too hard like it’s uncomfortable and it hurts when I smile and make certain movements with my nose. And when I touch underneath my nose, it’s a pain I feel like the bone is stabbing. Is any of this normal and will it go back to normal or is this permanent?

    Reply
    • It will improve. It might take 2-3 weeks if it was a large flap access. Many of the procedures I do like zygomatic implants require that I expose the bottom of the nose through the mouth. Those patients also feel a little bit of that. Usually a steroid dose pack helps all of that but that is usually prescribed before the procedure not after.

      Reply
  14. I have had bone graft and tissue reconstruction where dentist harvested tissue from the roof palate. There was stitches to fold back the cut but one of the stitches fell out 3 days later. It’s now day 5 and I have excruciating pain around the area. I’m taking pain killers but the pain is not going away. Is this normal to have pain on day 5 and when should I see this pain go down. It feels like a extremely bad burn pain times 100 on the roof of the mouth.

    Tissue around the bone graft is healing nicely. No pain. Also no smell from mouth.

    Thanks.

    Reply
    • It sounds like he did not have any sort of surgical covering on the roof of the mouth. The dentist might be able to make you a quick “suck down stent.” This is pretty quick and easy and will give you some comfort while the area heals. Keep in mind that adding gum from the roof of the mouth is such a great benefit long-term. It would be worth the pain!

      Reply
      • Thanks doctor, what do you mean by the stint would be a great benefit long term ?
        I was under the assumption the hole would heal back fully in 2-3 months ?

        Reply
          • Thanks doctor Ramsey. You are really doing a great thing here helping so many people like myself to have someone professional to ask concerned questions to. So thank you.

            You say 4 weeks. Will the rooftop of mount fully smoothen out again ? or will it always have slight bumps where the hole meets the sides of where the original skin is.

  15. Hi Doctor 👋🏽

    I had a bone graft surgery about 3 weeks ago. They pulled my gums back, cleaned the infection and packed it with bone graft material. My concern is that my gums won’t grow back to the way they were before. I feel like I have a hole in my mouth. I recently had this tissue like piece attached to my gums where the procedure was done and space is between my teeth that had the bone lost. I wasn’t sure if it was food or what but when I brushed my teeth it didn’t detach. I brushed my teeth tonight, maybe too hard and it came out kind of looked and felt like wet paper? Is that normal? Was that my gum growing back? Will it come back now I’ve brushed it off?

    Reply
    • I think I already replied to you? If I did not please cut and paste your entire message back to me.

      Sounds like possibly her membrane came out. Regardless you should see your dentist right away.

      Reply
      • I had a bone graft for my front tooth. 9 days ago. I still have pain . I don’t take anti inflammatory as I take methotrexate. I can take paracetamol but I don’t want to take it anymore as I’ve been taking it for 9 days, although it does help. Is it normal after 9 days. I was gargling with mouth wash but have now stopped and just use salt water. I have no bleeding and no bad taste in my mouth. I am due to get my stitches out in 6 days. Is it normal to still have pain 9 days later?

        Reply
  16. Hello Doctor Amin,
    I am hoping you are still responding to this thread, however I can see it has been a while. I will try nevertheless. Around the 21st of January 2021 I had a lower, left side molar extracted and bone graft done to prepare for an implant. I know the graft was granular, but don’t know what it was made from. Everything went fine, very little swelling or pain even though the molar and the roots were quite large. The stitches dissolved after about six days. Things seemed to be going well. Then about three weeks ago I began to notice what felt like a divot, or small depressed area on the otherwise smooth surface of the graft bed. I went to the OS and he said it was fine; that the granular filler sometimes shifted or moved. He gave me a syringe to wash it out with. It has become sensitive, especially when I brush or even touch my tongue to the area. It also seems to be getting bigger, and moving back up against the bottom of the molar behind the one that was pulled. I had an implant years ago on a different tooth and did not experience anything like this. Is this an indication that the graft is failing? Isn’t it a little late for that to be happening? It’s been two months since the procedure. The rest of the graft surface is smooth and not at all painful. I do so hope to get a response. Thank you in advance.

    Reply
    • Yes I am still responding all these years later!

      Likely this is just some of the top part of the graft that did not consolidate. It does not mean that the bone graft is failing which would lead to a failed implant. When the gum gets reopened to place the implant, that week part of the bone can be removed and even re-grafted if necessary at the same appointment

      Reply
      • Thanks so much for your response. My appointment to have the screw installed is next week. The bone sliver is definitely bigger, but no longer sensitive. There seems to be much more smooth surface over the graft than the small sharp spot. The smoothe surface of the graft feels pretty solid, and thick. I appreciate your reassurance as, it seems, do many others on this site.

        Reply
  17. I had a tooth extraction and bone graft 6days ago . I smoked two puffs of marijuana . Will that affect my bone graft for dental implant in the long run ? I have decided to stop smoking so I can get the results I want for my teeth but I’m worried that becuase I smoked a little it will affect my results . Please let me know

    Reply
  18. Hello, I’d like to know if the bone graft area becomes thinner while healing/ integrating the bone. I had a bone graft recently and I feel it is very thick inside (like the amount of bone is too much). Does it become thinner in time? It feels uncomfortable to me like it is now…

    Reply
    • That’s a good thing! But typically over the 4 to 6 month healing duration it will feel like the area shrinks a bit. Always better to have a bit more then less. The extra bone can be trimmed away if necessary. 😊

      Reply
      • Hi Dr! I had an extraction and bone graft 4 days ago I’ve been following all after care procedures. I noticed it now looks like there’s a big hole where they did the bone graft and that I felt little itty pieces of the bone graft in my mouth which my dentist said is normal. I still see the white of the bone graft but also a hole. And my mouth has tasted terrible even with brushing since the surgery. it’s been 4 days and I’m still in pretty good amount of pain. A little part of my gums where my stitches are is red. I swished gently with salt water. And I’m taking my pain pills to help but I’m wondering if this is normal. I thought the pain would be subsiding but it seems very tender. I’m not sure what’s normal. Help

        Reply
    • I had 8 extractions and 2 bone graphs and all on 4 implants 4 days ago. The pain is excruciating. And my mouth stings like my gums burn. Can’t eat anything. I’m scared I made a bad decision. When will I be able to take in food or drink warm coffee. And will these stitches come out on there own or will the Dr. remove them. Now I regret the decision without realizing how evasive this would be. Let me know please

      Reply
      • I’m sorry you’re having a bad experience. I’ve noticed that this procedure for full arch Implants has a wide variety of provider experience level. In some cases are just much more difficult such as my zygomatic cases.

        In general my patients have no pain for several days in action they’re quite surprised that they don’t take anything beyond ibuprofen or Tylenol. But there is a lot I do to make this happen

        https://burbankdentalimplants.com/service/full-mouth-dental-implants/

        Hopefully the sutures that are in there are dissolvable considering you have immediate bridges in place.

        I am assuming you are on an antibiotic, steroid, Ibuprofen, Tylenol, Mobic, and or ancillary medications maybe gabapentin?

        You’ll be on soft foods for a while

        Speak to your dentist about pain control. It’s worth reaching out to them after hours. You should not be suffering with pain

        Reply
  19. Hello, Dr. Ramsey!

    I am thankful that I found you online!
    I just had a bone graft in my lower front teeth. In my case, I need it because genetically my bones are really thin in that area and won’t support my bracers. I have a mild case of an underbite. I can have maxillofacial surgery but the ortho says is not extremely needed, unless I want perfectly aligned teeth. Therefore, we are just doing bracers.

    My face is swollen, which is normal, but my chin specially looks very big. I was not planning to get maxillofacial surgery, but I am afraid that after the bone graft my underbite is more prominent.

    So my question is, can I bone graft change or worsen my underbite and my profile? My doctor says no, but I look so different and my underbite looks really bad now. So I am really afraid of the outcome. Thanks!

    Reply
  20. Dr. Amin:

    It’s amazing that you’ve taken the time to answer everyone, wow. Thank you in advance for your efforts and responsiveness.

    My implant story is a bit confusing as it just happened yesterday and I’m having trouble finding any similar stories or information online.

    I planned to have an implant placed yesterday in #5. The tooth (#5) was removed approximately 4 months ago, around Thanksgiving. When the tooth was removed – the bone graft (allograft) was added to the socket, in preparation for the implant.

    Now, I had a full 360 x-ray scan done about 2 weeks ago, in preparation for yesterday’s implant procedure. Unfortunately, when they tried to place the implant yesterday – both surgeons were having trouble getting the appropriate torque and depth (as far as I could tell as a non-medical professional having the procedure done) and they decided not place the implant. They added more bone graft material to the socket, stitched me up, and gave me the bad news – that the bone was too soft (not fully healed) and they had decided not to place the implant.

    This was in the post-graduate oral surgery clinic of the largest university dental program in Illinois. Franky, and somewhat obviously, I was extremely disappointed that they couldn’t tell from the x-rays that the graft still needed time to heal. Now, I’m going to have to wait another 6 months to have #5 re-evaluated – when I would have been happy to wait another few months for the initial bone graft to heal properly.

    As I’ve seen numerous articles (and have been told by my student dentist and other oral surgeons) that a bone graft can be done at the same time an implant is placed – I’m somewhat confused and wondering if they made a some kind of mistake? It seems that with the 360 x-ray scan, they should have been able to tell that the bone needed more time to heal and I would have to wait to have the implant placed. The school has the all latest digital x-ray equipment and an array of doctors and technicians with vast experience which, again, makes me wonder how this could happen.

    It seems that the probability everything was good to go and the bone was healed properly, would be extremely high, around 96% otherwise, they wouldn’t have proceeded. They did say that they wouldn’t know for sure how everything really looked until they actually had a chance to see for themselves. Again, it just seems that trying to place the implant yesterday was a mistake. While I’m completely healthy and implants are ultimately a cosmetic procedure I’m still extremely disappointed how this has played out.

    I also had two abutments placed in other implants yesterday (successfully, on the other side of mouth from #5) and while it would have been nice to have the implant in #5 placed successfully as well – it seems like they might have been a bit overzealous in wanting to do “everything” at the same time (which I was as well but, I would have been happy to follow their guidelines for healing).

    Hopefully this description makes sense. If there is any insight you could add that would be amazing as I can’t quite find anything about implants not being placed when everyone is prepared to place them.

    Thanks again in advance! –Josh

    Reply
    • Hello Josh!

      Thank you for your kind words and your detailed question.

      Even with the latest technology there are times where it can be impossible to know what the bone is going to feel like at the time of actual exposure. Some dental surgeons used bone products that looked very white on x-ray so they appear to be healed. Think of it like oatmeal that sat out for too long. You do not know the consistency until you actually tried to stick a spoon into it. It still could be soft or it could be hard like a rock but it appears to be the same on the surface

      The bone that I use and methods for placement allow me to precisely tell not only the bone volume but the bone quality in advance of the procedure. My guess is that he used a material that looks fairly white from the get go and it was too soft at the time of placement.

      The good news is they did the right thing. Putting implants into bone that is too soft surely going to end up as a failure.

      Nothing beats experience. Technology helps but it can often be a crutch.

      Let me know you receive this reply 😉

      Reply
      • Dr. Amin,

        Thank you for your response – I sincerely appreciate it. I was obviously disappointed that they couldn’t place the implant and that I’m going to have to continue to wait. However, it is comforting to know that they ultimately did the right thing by not placing the implant when the graft was too soft.

        Thank you again for taking the time to respond!

        –Josh

        Reply
    • OMG! This is exactly what happened to me yesterday! After two hours my Dentist says he cannot place the implant and does another graft . Left me with a swollen face and pain. This occurred 6 months after the initial grafting and an expensive Cat scan later. Needless to say I have lost confidence in my Dentist!

      Reply
  21. Hello Dr. Amin,

    I had a bone graft on Dec 30, 2020, in my lower jaw due to an impacted wisdom tooth. One thing that happened to me was that the white adhesive covering the area came off on the 2nd day after the surgery. But when I got the stitches removed, I noticed some leakage that looks like tiny thin white crumbs. My dentist prescribed me Chlorohexine for 12 days, but the area is still leaking tiny white particles (almost liquid). So, I am worried because I read that it can be a sign of bone graft failure. (I do not have pain nor fever). In your experience, is it normal? What are your recommendations?

    I really appreciate any recommendation you can provide!

    Best regards,
    Cristina

    Reply
      • Dr. Amin,

        The first bone graft did not work because of two things. The first thing is that I had wound dehiscence and the second one is because the oral surgeon left the root of the wisdom tooth inside. So, I had another surgery on March 8th to remove the root; and therefore, the oral surgeon had to redo the bone graft. It is now day 6 after the surgery, and I will get the stitches removed on March 17th.

        What should I do if I continue to have leakage?

        Reply
          • It’s the left lower jaw. It is only the graft for a wisdom tooth. I think it is tooth #17. I am currently taking ampicillin 4 times a day.

            Will I need a gum graft if I continue to have the leakage?

          • I’m sorry to tell you but bone graft for a wisdom tooth is pretty much useless. Unless you had some strange pathology or a large cyst/tumor wisdom teeth sockets heal on their own without intervention

            If it’s giving you a problem I would just remove it let heal on its own.

      • I had a removal of lower tooth, right side #31 a week ago with particulated cadaver bone. The site is healing well, but I’m Ive accidentally chewed on that side one time forgetting my tooth is gone. Did I mess up my graft?

        Reply
  22. Hi Dr. Amin,

    I’ll be seeing my dentist for a follow up appointment next week or so, but out of an abundance of caution, I thought I would ask you for your opinion on whether I should see him again sooner… And maybe start on another round of antibiotics.

    So here’s the deal:

    I cracked my first upper molar so badly that it split the crown down to the gum line. It was an otherwise healthy tooth with no decay, but because of the split, it couldn’t be saved and so I got it pulled.

    My dentist was thorough with his post-extraction cleaning and after taking x-rays to make sure all of the tooth was removed, he did a bone graft (particles, not block) because we plan to do an implant once it all heals.

    The area was sutured with a collagen plug put into place and I was told to continue my antibiotics (which I had started one day prior) and was given aftercare instructions.

    I have followed the instructions carefully since, and now that it’s been one week, the plug seems to have dissolved which my dentist had told me was to to be expected.

    My question / concern is this:

    I haven’t had pain at the extraction site – no need for painkillers at all, but once the plug dissolved, I can see that the gum hasn’t healed over the site yet, I can see a bit of the bone graft (at least that’s what it looks like) under the sutures with a bit of space on top, and I have started losing a little particle here and there which hadn’t happened when the plug was still in place.

    Is all of this normal for the healing process? Should I see my dentist sooner? Do you think another round of antibiotics might be useful to continue to prevent infection?

    I’ve been extra careful in rinsing gently with salt water, eating only soft foods, and gently brushing my other teeth with an extra soft tooth brush, but I can’t help but be a little worried that my body may reject the graft.

    I have had a history of tooth death without obvious cause – I had to root canal my two bottom pre-molars on each side about 10 years ago because they died and with no cavities and no periodontitist – and my previous dentist had suggested that I may have had an issue with blood flow.

    I know the upper molars have less trouble with such things, but I also know that blood flow / supply in general can be an issue for healing as well.

    Any thoughts?

    Reply
    • That sounds pretty normal for the type of graft that you had. It sounds like you had a socket preservation graft at the time of extraction.

      Unless you are a smoker or have overly dense bone blood flow is not an issue on the upper jaw for the most part.

      This should all heal fine 😉

      Reply
  23. Hi Dr. Amin,

    I’ll be seeing my dentist for a follow up appointment next week or so, but out of an abundance of caution, I thought I would ask you for your opinion on whether I should see him again sooner… And maybe start on another round of antibiotics.

    So here’s the deal:

    I cracked my first upper molar so badly that it split the crown down to the gum line. It was an otherwise healthy tooth with no decay, but because of the split, it couldn’t be saved and so I got it pulled.

    My dentist was thorough with his post-extraction cleaning and after taking x-rays to make sure all of the tooth was removed, he did a bone graft (particles, not block) because we plan to do an implant once it all heals.

    The area was sutured with a collagen plug put into place and I was told to continue my antibiotics (which I had started one day prior) and was given aftercare instructions.

    I have followed the instructions carefully since, and now that it’s been one week, the plug seems to have dissolved which my dentist had told me was to to be expected.

    My question / concern is this:

    I haven’t had pain at the extraction site – no need for painkillers at all, but once the plug dissolved, I can see that the gum hasn’t healed over the site yet, I can see a bit of the bone graft (at least that’s what it looks like) under the sutures with a bit of space on top, and I have started losing a little particle here and there which hadn’t happened when the plug was still in place.

    Is all of this normal for the healing process? Should I see my dentist sooner? Do you think another round of antibiotics might be useful to continue to prevent infection?

    I’ve been extra careful in rinsing gently with salt water, eating only soft foods, and gently brushing my other teeth with an extra soft tooth brush, but I can’t help but be a little worried that my body may reject the graft.

    I have had a history of tooth death without obvious cause – I had to root canal my two bottom pre-molars on each side about 10 years ago because they died and with no cavities and no periodontitist – and my previous dentist had suggested that I may have had an issue with blood flow.

    I know the upper molars have less trouble with such things, but I also know that blood flow / supply in general can be an issue for healing as well.

    Any thoughts?

    Reply
    • That sounds pretty normal for the type of graft that you had. It sounds like you had a socket preservation graft at the time of extraction.

      Unless you are a smoker or have overly dense bone blood flow is not an issue on the upper jaw for the most part.

      This should all heal fine 😉

      Reply
  24. 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.

    Reply
    • 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

      Reply
  25. 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.

    Reply
    • 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

      Reply
      • I had #30 extracted and a bone graft place six weeks ago. Today a piece of the bone graft came out (like a small piece of hard material). Does this mean the graft is failing? There is no pain or swelling.

        Reply
          • Hi , doctor I just had a bone graft and teeth implant on my upper jaw front teeth 9days ago , the doctor take off my stitches yesterday but my wound is still bleeding and some small pieces of bone graft is falling off I feel like my wound is open should I meet the doctor and have a check? And what should I be cautious of . Thanks doctor

          • It is a bit odd that you are oozing blood 9 days later. That is likely not allowing the graft to stick together. You should possibly be checked for a bleeding disorder although that is unlikely. That is done through your doctor with a simple blood draw. Some people take blood thinners which makes them bleed for much longer. You should see the dentist for sure but this is nothing to be worried about.

          • Check your email to confirm your subscription.

            Hi , doctor I just had a bone graft and teeth implant on my upper jaw front teeth 9days ago , the doctor take off my stitches yesterday but my wound is still bleeding and some small pieces of bone graft is falling off I feel like my wound is open should I meet the doctor and have a check? And what should I be cautious of . Thanks doctor

  26. 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.

    Reply
  27. 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?

    Reply
    • 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!!

      Reply
      • 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

        Reply
      • 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?

        Reply
      • 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!

        Reply
        • 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??

          Reply
    • 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?

      Reply
    • 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?

      Reply
      • 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.

        Reply
        • Dear Dr Amin,
          Following a failed root canal, I had molar 14 extracted in May 2019. Graft material (human source) was applied during the extraction. In the immediate weeks that followed, I had severe discomfort and inflammation and my OS prescribed multiple courses of antibiotics and then a steroid to control inflammation.
          It is now October and I continue to have an odd taste that seems to be associated with the extraction site (no bad breath, no fever) along with persistent discomfort. No added pain when I chew and no hot/cold sensitivity.
          My oral surgeon sees no sign of infection, but has told me he has no experience with someone having this degree of difficulty following an extraction and has no further recommendations.
          My questions — is it within the range of normal to still have discomfort and an odd taste five months post extraction/graft or is there potentially an underlying problem (infection in the graft material, failed rejected graft, ….)? Would an infection or failed graft show up in an Xray or CT scan? Are there other diagnostics to evaluate for a failed graft? How much longer should I “wait and see”? I am reluctant to move forward with the implant until I have some confidence that I have healed properly from the extraction and graft.

          Reply
        • Hi Doctor! I had bone grafting done on my upper right jaw. A week later I noticed I can’t fully smile like I use to. That area is so stiff and when I noticed the stitches have made my lips move a bit lower (if that makes sense). I’m very worried my smile will never be the same. My dentist said nothing should change but why is this happening. How long will it take to get my smile back to normal?

          Reply
  28. 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?

    Reply
    • 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

      Reply
      • 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!

        Reply
        • 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.

          Reply
        • 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..

          Reply
    • 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.

      Reply
  29. 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.

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

      Reply
    • I’ve had similar issues. Upper right molar. Failed crown. Broken tooth. Tooth was broken trying to get it out. Very traumatic experience.
      Bone grafted and sutured. I’m day 8 post-op and it still hurts.
      I’m trying to post a pic but can’t figure out how. My bf is an RN and he said it isn’t red. I’m on my 2nd round of amoxicillin. Is it normal to still have pain on the 8th day?
      Thank you so much.

      Reply
  30. 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.

    Reply
  31. 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.

    Reply
    • 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. 😉

      Reply
  32. 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.

    Reply
    • 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.

      Reply
  33. 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.

    Reply
    • 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

      Reply
  34. 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.

    Reply
    • 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

      Reply
  35. 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?

    Reply
  36. 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?

    Reply
    • 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

      Reply
  37. 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

    Reply
    • 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.

      Reply
    • 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?

      Reply
  38. 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,
    Sandy

    Reply
    • 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

      Reply
    • 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.

      Reply
  39. 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 !!

    Reply
  40. 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.

    Reply
  41. 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?

    Reply
    • 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!!😁😁

      Reply
    • 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.

      Reply
    • 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

      Reply
      • 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. 🤞

        Reply
  42. 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?

    Reply
    • 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.

      Reply
  43. 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

    Reply
    • 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!

      Reply
  44. 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?

    Reply
  45. 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

    Jeremy

    Reply
      • 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.

        Reply
  46. 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!

    Reply
  47. 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.

    Reply
  48. 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?

    Reply
    • 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.

      Reply
  49. 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.

    Reply
  50. 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?

    Thanks!

    Reply
  51. 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

    Reply
  52. 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

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

      Reply
  53. 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

    Reply
      • 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

        Reply
        • 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.

          Reply
  54. 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?

    Reply
    • 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.

      Reply
  55. 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?

    Reply
    • 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.

      Reply
      • 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

        Reply
  56. 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!

    Reply
    • 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
      Abstract
      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.

      Reply
      • 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

        Reply
        • 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.

          Reply
        • 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.

          Reply
    • 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.

      Reply
  57. 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.

    Reply
  58. 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.

    Reply
  59. 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!!!

    Reply
  60. 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?

    Reply
    • 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. ;-(

      Reply
  61. 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

    Reply
  62. 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! 🙂

    Reply
  63. 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?

    Reply
    • 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.

      Reply
      • 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?

        Reply
  64. 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!!

    Reply
    • 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)

      Reply
      • 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!!

        Reply
  65. 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…

    Reply
    • 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!

      Reply
    • 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.

      Reply
  66. 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!

    Reply
  67. 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.

    Thanks

    Reply
  68. 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,
    Sebastian

    Reply
    • 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.

      Reply
  69. 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?

    Reply
  70. 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?

    Reply
      • 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?

        Reply
          • 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?

  71. 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!

    Reply
      • 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!

        Reply
        • 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.

          Reply
  72. 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”

    Reply
  73. 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.

    Reply
  74. Hi Dr.,

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

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

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

    Best regards,
    Anouar

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

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

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

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

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

      You should not have to live like this!

      Hope this helps.

      Reply
    • 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.

      Reply
      • 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

        Reply
      • 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.

        Reply
    • 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)

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

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

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

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

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

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

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

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

      Reply
  83. Dr Amin,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      Reply
      • 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”.

        Reply
        • 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.

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

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

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

      Reply
  93. Dear Dr. Amin,

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

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

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

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

    Thanks for any help you can provide.
    Susan

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

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

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

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

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

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

    Scot

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

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

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

      Reply
      • 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?

        Reply
        • 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.

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

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

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

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

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

      I hope you are better now. 🙂

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

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

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

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

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

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

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

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

        Reply
          • 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??

          • 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?

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

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

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

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

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

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

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

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

      Reply
  105. Hi!

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

    Thank you!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      Reply
  112. Please help.

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

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

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

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

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

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

      thank you for your kind words

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

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

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

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

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

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

    Reply
  118. Hello,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Reply
  125. hello there Dr. Amin~

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

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

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

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

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

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

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

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

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

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

      Reply
  128. Hello Dr. Amin,

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

    Thanks again!

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

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

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

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

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

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

    Thank you!

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

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

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

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

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

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

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

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

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

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

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

      this link should help you

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      Reply
  141. Dr. Ramsey,

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

    Thank you

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Thank you in advance

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      Ramsey Amin DDS

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

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

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

      The lower jaw in general tends to have more pain.

      bone graft materials

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

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

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

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

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

    Reply
  156. Hi Dr Ramsey,

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

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

    Here’s my questions:

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

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

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

    Thanks Again!

    Reply
    • hello Tom,

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

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

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

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

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

    Reply
  158. Hi,

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

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

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

    Many Thanks

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

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

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

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

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

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

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

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

      Reply
  162. Dear Dr Amin

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

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

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

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

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

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

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

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

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

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

    Reply
  165. hi,

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

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

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

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

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

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

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

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

    Reply
  169. Hi there,

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

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

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

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

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

    Thank you.

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

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

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

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

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

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

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

      Ramsey Amin DDS

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

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

      Respectfully,

      Ramsey Amin DDS

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

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

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

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

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

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

      Ramsey Amin DDS

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

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

      Reply
  177. Dear Dr Amin,

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

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

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

      Keep us posted on your healing.

      Respectfully,
      Ramsey Amin DDS

      Reply
  178. Hello Dr. Amin,

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

    Reply
    • Hello Tom,

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

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

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

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

      I hope this helps you

      Respectfully,

      Ramsey Amin DDS

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

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

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

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

    Reply
      • 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?

        or

        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!

        Reply
        • 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.

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

    Reply
    • Hello Alex,

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

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

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

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

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

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

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

      Good luck.

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

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

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

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

      Good luck.
      ????

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

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

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

    Thank you,
    Peter Simcock

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

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

    Is that normal Doctors ?

    How many days I should wait ?

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

    Reply
    • 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

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

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

    Reply
    • hi Donna,

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

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

      Ramsey Amin DDS

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

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

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

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

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

    Sending you my regards,

    Thank you

    Reply
    • Hello Audrey,

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

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

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

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

      Very Respectfully,

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

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

        Kindest regards,

        Audrey

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

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

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

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

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

      Respectfully,

      Dr. Amin

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

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

      Here’s some more information about PRF.

      Good luck

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

      Reply
  194. 4 years ago I was hit with a baseball and suffered the loss of my front two teeth. One was able to be salvaged and the other one was not. I am now 17 years old and undergoing the process of recieving an implant. About two weeks ago I recieved a bone graft using titanium mesh to build width for an implant down the road. A few days went by during the healing process and then I hit an obstacle-an infection. It was taken care of immediately. Now im on the road to recovery with almost all of my stitches and sutures still intact. I have noticed my gums above and around my missing tooth have been drastically receding. Around two hours ago I noticed a large portion of the titanium mesh is showing through my gums. I have no pain and no blood. I thought that would be expected for such a large gap in my gums. Sorry for the length of this question. I’m just wondering if this is normal or if it should be taken cafe of immediately. Please respond promptly. Thanks

    Reply
    • Here is an article on titanium mesh reconstruction bone grafting.

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

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

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

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

      Good luck,

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

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

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

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

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

    Reply
    • Hi Lourdes,

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

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

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

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

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

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

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

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

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

      Is it an upper tooth??

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

    Thanks& Regards,
    Raj Kumar.

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

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

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

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

    Reply
    • Hello Carolyn,

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

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

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

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

      Ramsey Amin DDS

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

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

    Reply
    • Hi Irma,

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

      Take care.

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

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

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

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

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

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

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

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

        It seems to be getting worse before getting better.

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

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

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

    Reply
    • Hi Stacey,

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

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

      Respectfully,

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

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

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

    Reply
    • The undifferentiated connective tissue disease worries me.

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

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

      good luck…

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

      Reply
  208. Hi Dr. Amin,

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

    Thanks,
    Tiffani

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

    Reply
    • Hello Teresa,

      Not sure I totally understand your question.

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

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

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

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

      sinus lift basics

      Very Respectfully,

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

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

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

    Your opinion will be appreciated.

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

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

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

      3-D scan basics

      immediate placement

      Very Respectfully,

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

      Reply
  211. Hi,

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

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

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

    Regards.

    Reply
    • Hello Rachel,

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

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

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

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

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

      I hope this helps.

      Respectfully,

      Ramsey Amin DDS

      Reply
  212. Dear Dr. Ramsey,

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

    Thank you for your kind help in advance,

    Katica

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

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

      Ramsey Amin DDS

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

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

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

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

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

      Very respectfully,

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

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

    Reply
    • Hello Tracy,

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

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

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

      Very respectfully,

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

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

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

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

    Reply
    • Hello Nadar,

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

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

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

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

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

      Very respectfully,

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

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

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

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

    Thank you so much.
    Hong

    Reply
    • Hi Hong,

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

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

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

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

      Respectfully,

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

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

    Reply
  220. Hi Dr. Amin,

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

    Reply
    • Hello Suzi,

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

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

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

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

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

      Good luck,

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

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

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

    Reply
    • Hello Carol,

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

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

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

      Good luck,

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

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

    Reply
    • Hi Hossam,

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

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

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

      Very Respectfully,

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

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

    Reply
    • Hi Hossam,

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

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

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

      Very Respectfully,

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

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

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

    thank you
    Kairi

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

    thank you
    Kairi

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

    Reply
  229. Hello Dr. Amin,

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

    Also, when can I use regular mouth wash again?

    Thank you!
    Kimberly

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

    Reply
    • Hello DeeDee

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

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

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

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

      Very respectfully,

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

      Reply
  231. Hello Dr Amin

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

    Reply
    • Hello Scott,

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

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

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

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

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

      3D Scan

      Smile Gallery

      Gum Grafting

      Very Respectfully,

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

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

    Reply
    • Hello Wyatt,

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

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

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

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

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

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

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

      Good luck. I hope you get better soon.

      Respectfully,

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

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

    Reply
    • Hello Michaela,

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

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

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

      Short Dental Implants – A Unique Solution to Avoid Nerve Damage

      Nerve-Repositioning for Lower Dental Implants

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

      Respectfully,

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

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

    Reply
    • Hello Mike,

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

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

      3D Scan

      Computer Guided Dental Implant Surgery, Things You Need To Know

      I hope this helps you,

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

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

    Reply
    • Hello Victoria,

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

      Smile Gallery

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

      Respectfully,

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

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

    I now have to worry until December 15, 2014.

    Reply
    • Hi Kristine,

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

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

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

      Losing Bone on My Dental Implant -Too Much Cement?

      Very respectfully,

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

      Reply
  237. Apologies – resubmitting as I left incorrect email address

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

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

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

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

    Thanks in advance for any input.

    Reply
  240. Hello Dr. Amin

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

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

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

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

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

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

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

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

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

    Reply
    • Hi John,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Reply
    • Hello Candice,

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

      Very respectfully,

      Ramsey Amin DDS

      Reply
  247. Hi Dr. Amin,

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

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

    Sarah

    Reply
    • Hello Sarah,

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

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

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

      Ramsey A. Amin, D.D.S.

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

      Reply
  248. Hello Dr. Amin,

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

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

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

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

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

    Reply
    • Hello Karen,

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

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

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

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

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

      Respectfully,

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

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

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

    Reply
    • Hello Diane,

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

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

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

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

      Very respectfully,

      Ramsey A. Amin, D.D.S.

      Reply
  250. Hi

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

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

    Reply
    • Hi Debra,

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

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

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

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

      Please see this link for some clarification:

      Sinus Lift Bone Graft

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

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

    Reply
    • Hello Nicole,

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

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

      this link may help you with some concepts:

      Extraction Socket Bone Graft

      Very respectfully,

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

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

    Reply
    • Hello Rhonda!

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

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

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

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

      😉
      Very respectfully,

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

      Reply
  254. Hello!

    Your website is fantastic.

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

    Reply
    • Alyssa,

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

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

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

      Ramsey Amin DDS

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

    Reply
    • Hi Jackie,

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

      I look forward to meeting you
      😉
      RA

      Reply
  256. Dr. Ramsey,

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

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

      Ramsey Amin DDS

      Reply
  257. Hi,

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

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

    Reply
    • Hello Samantha,

      What you describe is not completely uncommon.

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

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

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

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

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

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

    Reply
    • hello Jackie,

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

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

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

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

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

    Reply
    • Hi Bev,

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

      Respectfully,
      Ramsey Amin DDS

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

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

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

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

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

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

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

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

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

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

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

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

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

    Reply
    • Hello Miriam,

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

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

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

      Reply
  263. Good Afternoon Dr. Amin,

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

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

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

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

    Regards,
    Stephanie

    Reply
    • Hello Stephanie,

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

      Reply
  264. Hello Dr,

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

    Thank you for taking the time.

    Reply
    • Hi Hanna,

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

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

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

    Reply
    • Hi Margaret,

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

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

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

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

    Thanks.

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

      Good luck,
      Ramsey Amin DDS

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

    Reply
    • hello Brenda,

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

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

      Good luck to you… Keep us all posted

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

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

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

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

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

    Reply
    • Hi kathy,

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

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

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

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

    Reply
    • Hi Selene,

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

      Next time, travel to Burbank. 😉

      Again thank you for your very flattering words

      Dr. Amin

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

    Reply
    • hi Karen,

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

      Dr. Amin

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

    Reply
    • Hello Siobhan,

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

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

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

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

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

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

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

    Reply
    • Hello Laura,

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

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

      Saving loose teeth is never a good idea.

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

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

    Reply
    • Rochelle,

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

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

      Reply
  275. Hi Dr. Ramsey,

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

    Thanks,
    Ray

    Reply
    • Hi Ray,

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

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

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

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

      Good luck!!

      Dr. Amin.

      Reply
  276. Dear Doctor Ramsey,

    I had 2 extractions upper jaw molars on same side.

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

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

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

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

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

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

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

    Gita

    Reply
    • Hi Gita,

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

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

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

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

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

      I hope this helps you.

      Respectfully

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

      Reply
  277. Hello Dr. Amin,

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

    Reply
    • hello Rex,

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

      Reply
  278. Hi Dr Ramsey,

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

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

    Is this normal?

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

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

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

    I appreciate your input and professionalism.

    Joseph

    Reply
    • Hello Joseph,

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

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

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

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

      Reply
      • Hi Dr Ramsey,

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

        Reply
      • Hi Dr Ramsey,

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

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

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

        Reply
        • Hi Joseph,

          It sounds like you are in good hands.

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

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

          Dr. Amin.

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

    Reply
    • Hello Paige,

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

      Very respectfully,

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

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

    Reply
    • Greetings Anna,

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

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

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

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

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

    Reply
    • Hi AD,

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

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

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

    Reply
    • Hi Jordan,

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

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

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

    Reply
    • Hi Carolyn,

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

      Dr. Amin

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

    Reply
    • Hello Carolyn,

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

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

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

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

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

      https://www.burbankdentalimplants.com/what-is-a-block-bone-graft-associated-with-dental-implants-video/

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

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

      Keep me posted,

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

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

        Reply
        • Dr. Amin,

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

          ~Sarah

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

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

            Ramsey Amin, DDS

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

    Reply
  288. Hello Dr. Amin,

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

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

    Reply
    • Hello Paul,

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

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

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

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

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

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

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

    Reply
    • Hi Kirsten,

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

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

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

    Reply
    • Hi Lisa,

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

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

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

    Reply
    • Hi Hanna,

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

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

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

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

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

    Reply
    • Hi Laura,

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

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

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

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

    Reply
    • Hi Carol,

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

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

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

    Reply
    • Hi Diana,

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

      Good luck. You will heal!!

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

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

    Reply
    • Hi Joe,

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

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

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

    Thank you for your help,

    Kimberly

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

    Reply
    • Hi Nikki,

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

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

      Keep me posted or come see me in Burbank!
      😉

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

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

    Reply
    • Hi Ryan,

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

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

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

    Reply
    • Hi Aleida,

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

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

      How is it now?

      Reply
  303. Hello Dr. Amin,

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

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

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

    Reply
    • Hi Arlene,

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

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

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

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

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

    Reply
    • Hi Alma,

      Thank you for your kind words.

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

      https://www.burbankdentalimplants.com/prp-vs-bmp-for-dental-implant-bone-grafts/

      Heal up!

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

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

    Reply
    • Hi Chris,

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

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

      Reply
  309. Hi Dr Amin,

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

    Reply
    • Hi Jennifer,

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

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

      Good luck and keep me posted.

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

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

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

        Reply
        • Hi Sandy,

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

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

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

          Reply
  310. Dear Dr. Amin,

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

    Reply
    • Hi Hodeah,

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

      High bone density…usually found in the front teeth areas

      High initial torque.

      Favorable bite pattern

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

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

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

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

    Really hope to hear from you soon

    Reply
    • Hi Ana,

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

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

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

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

      Good luck!

      Dr. Amin 🙂

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

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

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

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

    Reply
    • Hi Hemans,

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

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

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

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

      Good luck!

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

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

    Reply
    • Hi Natasha,

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

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

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

      Reply
  314. Dear Dr. Amin,

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

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

    Thanks,
    Monica

    Reply
    • Hi Monica,

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

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

      Dr. Amin.

      Reply
  315. Hi again Dr.Amin,

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

    Thanks,
    Monica

    Reply
    • Hi Monica,
      After 15 days you should be on the mend unless it was a massive graft. Massive would be at least a 6 tooth section of teeth.
      You should have seen your dental implant dentist twice by now.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  316. I’m getting back to normal 4 weeks later after the block bone graft done on my lower jaw bone. Swelling is gone and no more pain. Thank God! Bless good doctors!!! My question is about resorption of bio oss bone graft. On my face (right side) bone graft area is a little visible. It looks slightly bigger than before. And I really love to have symmetric face features. But I can feel some lumpiness under my skin. It’s not swelling but block bone graft that make it look like that. So I hope that the graft will be resorpted slightly. my doctor said it will slowly get smaller for about 30 %. In your experience, what percentage of the block graft will be resorpted?

    Olivia

    Reply
    • Hi Olivia,

      30% is within range. I typically see about 10-20% shrinkage so I do overbuild with that in mind. The graft should not be exposed. Bio-Oss is cow bone.

      Severe pain is NOT common after even block bone grafting unless the graft is massive or you have a unique medical history.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  317. Dear Dr. Amin,

    I had tooth number 19 extracted on May 20 and a bone graft. My tooth was infected for close to 3 weeks before that and infected during the extraction but cleaned out. Previously, a dentist also tried to do a root canal on my tooth on May 16 but if failed, hence the reason for the extraction in addition to a tooth eating bacteria that had left open wounds on my tooth and eaten up parts of my tooth. (The dentist showed me the photos of the described above taken during the failed root canal). I have been on 3 cures of antibiotics since May 4: Amoxicillin and almost two cures of Penicillin, which I had to stop today since I developed an allergic reaction to it. Overall I finished 69 pills of penicillin/amoxicillin. I have also been taking Vicodin, Ketorolac and 800mg Ibuprofin and Motrin. The pain medications barely work, however.

    My question is, is it normal to still have pain from the surgery, now 10 days later? The pain still requires pain pain medication every 5-6 hours. The pain is pounding in my extracted tooth area, jawbone, inside my cheek, throat and up towards my ear. My face is still slightly swollen (10% swollen) and my throat feels sore and a bit swollen. I also have a bad taste in my mouth and a bad smell. I have been following post ops routine of warm saltwater rinses, dentist mouth water rinses, brushing with soft brush and flossing and not eating close to the tooth area. I do not smoke.

    Thank you for your reply.

    Reply
    • Hi Monica,

      I already answered your question on your second follow question. Hopefully you see the response and I hope you feel better!

      Intravenous and intramuscular corticosteroids would have helped prevent a lot of your problems. I do a ton of these over the last 14 years and rarely ever have patients on pain meds after 2 days.

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  318. I had an extraction and bone graft on tooth #31 on 3/15/13. Just wondering if it is normal to still be experiencing pain on a pretty regular basis?

    While I regularly experience a low pain tolerance, it is not usual for me to use all of a prescription pain medication for any dental procedure.

    I have been on a soft diet since the graft, using ice several times a day and limiting my activities when the pain becomes intolerable. I have noticed some swelling in the mornings but I clench my teeth at night and thought that may have something to do with it.

    The pain is a throbbing that comes and goes throughout the day and is worse if I bend or kneel. I am currently taking ibuprofen, amoxicillin and a non-narcotic pain medication. Is it customary to need additional pain medication after one week.

    I’m usually a trooper with no complications. Just a little discouraged. Any advise would be greatly appreciated. Many thanks in advance!

    Reply
    • Hi Meliss,

      I may not understand your question. You said the graft was done in March, but later said it has only been a week. Can you clarify this? If it is only a week, this would be within the range of normal.

      Some bone grafts I do are HUGE and others are tiny. The bigger grafts tend to have more post op pain. The technique is critical and so is your ability to heal.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  319. Yes it was my lover jaw. And I was told that bio-oss was used for my graft. My bone was not shrinking it was just too thin for immediate implant. That’s why he decided to thicken it. But I till have some numbness that worries me a lot. Done my surgery 9 days ago.

    Bellow is my previously asked question.

    I had bone graft (sugar like cube placed in my jaw) a week ago. The procedure went well with no pain involved. I had swelling and pain afterwards which I handled with painkiller for a few days and antibiotics. Swelling was persistent or even growing for 4 days then it started to get smaller. A week has passed and I still have a little swelling in the area and very little pain if I move my mouth too much. The concerning issue is that I have some numbness on my face in graft area and I’m so scared that what if the doctors damaged some of the nerves in my jaw bone. Should the numbness last for weeks? Is it normal that I still have some numbness, strange sensation started from graft area till the chin? PS I needed bone grafting because my bone was too thin for implant. Im 29 and yes shame that I have several missing teeth already.

    Reply
    • Hi Olivia,

      At nine days you are still within range for your sensation to return back to normal. Keep in close contact with your dentist and make sure he/she is aware of this.

      🙂 Dr. Amin

      Reply
  320. It is now six weeks after surgery and stitches taken out. Can’t understand why I’m still getting soreness on a daily basis, which is worrying.

    Reply
    • Hi David,

      I assume you have seen the dentist for multiple post op appts and rounds of antibiotics? What you are experiencing is not totally normal but within the range of normal. Most of my patients have zero pain after one week.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
      • I was put on Metronidazole 200mg four weeks prior to the op.
        and as said took Metronidazole 200mg again but no other antibiotic. What would possibly happen if the symptoms continue and get worse?

        Reply
  321. Hello, first of all thank you for this forum. I find your answers very helpful even if its not addressed to me. I had bone graft (sugar like cube placed in my jaw) a week ago. The procedure went well with no pain involved. I had swelling and pain afterwards which I handled with painkiller for a few days and antibiotics. Swelling was persistent or even growing for 4 days then it started to get smaller. A week has passed and I still have a little swelling in the area and very little pain if I move my mouth too much. The concerning issue is that I have some numbness on my face in graft area and I’m so scared that what if the doctors damaged some of the nerves in my jaw bone. Should the numbness last for weeks? Is it normal that I still have some numbness, strange sensation started from graft area till the chin? PS I needed bone grafting because my bone was too thin for implant. Im 29 and yes shame that I have several missing teeth already 🙁

    Reply
    • HI David,

      Was anything else given with the Metronidazole at the same time? 200mg or 500mg? It is often grouped with another antibiotic at the same time

      Dr. Amin

      Reply
  322. Hi,

    Just over a week ago i had an accident where i fell forward onto my mouth hitting a hard object. #7 was pushed directly up into my gum and #8 was pushed back into my palate. I lost quite alot of bone, both teeth were extracted and i went in for surgery where i had bone graft put in place. My concern is that the area is still swollen (especially my palate) but i can see abit of membrane but it looks as if there is not enough gum to cover it. Is it safe for this membrane to be exposed, the dentist says it is healing well and doesnt seem concerned! Thanks.

    Reply
    • Hi Beth,

      Some membranes can remain exposed and are purposely done this way. Others require that it stay covered like when doing titanium mesh bone grafting:

      titanium mesh

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  323. I had a tooth extraction but root was still left in. Had to see an oral surgeon to remove the root. Infection was found and he cleaned it all out. Straumann Bone Ceramic graft was immediately put in straight after the extraction with a membrane placed after for preperation of implant. Six weeks later, it is still sore and quite painfull. Is the pain and soreness normal healing symtoms or a sign of returned infection?

    Reply
    • David,

      What you describe can and does occur but maybe in only 5% of socket bone grafting. How long and what type of antibiotics are you on?

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  324. Hello,

    I had a bone block on #9 about 5 weeks ago. I got my braces taken off 3 weeks after the bone block and have been wearing a retainer. I take the retainer out to eat and have been trying not to chew with my front teeth too much. About 5-6 days ago I noticed white chunk sticking out of my gum. It seems to be getting worse and after touching it with a probe I know it is the bone block exposed. There is just a little big exposed right now, but I am wondering if the block has failed? There is a little bit of pain, but not much and I don’t see signs of infection. Please help!

    Reply
    • Hi Kai,

      You need to see your dentist asap. Exposure of the block bone graft is never a good thing. Keep me posted. Make sure to reference this post when you do.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
      • Thanks for the post, my surgeon wants to wait it out to see if “mother nature” will take care of it. If not, he said he will grind down some of the block and stitch the gum shut. Will this still be successful, and will the block heal to do an implant? I am only 26 y/o so I need this implant to last a lifetime preferably.

        Reply
  325. Hi. I just had a extraction and bovine bone graft yesterday. Today I am very weak and tired. I am 29 in good health. I was wondering how safe are these bone grafts when it comes to infections? Currently I am taking amoxicillin and I would like to make sure that I have nothing to worry about a possible infection. Thank you.

    Reply
    • Hi Tiscali,

      Bovine bone, which is cow bone, is safe and effective. Some bone banks are better than others and some have longer data. I use it all the time. You will do great! Infections due to bone type are uncommon. Infections due to technique or healing is relatively common.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  326. About 10 years ago as a child I had tooth 8 extracted and an an autologous and synthetic bone graft using Osteograf LD300 was placed. If there are no complications should this ‘site’ be ready for an implant or would more grafting needed?

    Reply
  327. Hi – me again. I had my other bone graft today. I asked what it was, and the nurse said it was coral?

    I have done nothing but read about bone grafts and have never seen coral. Is this a good thing or bad thing?

    Reply
    • Hi Bev,

      Coral is used for Hydroxyappetitie crystals. It does have some uses but is not as useful as others.
      The technique by your dental implant dentist is far more important than the graft or implant materials.

      Dr. Amin

      Reply
      • Well, he is an oral surgeon who has passion for surgery in his eyes (funny how you can see that)….so I trust that he did it right, whatever right might be!

        Reply
  328. Hello,

    I recently got a bone graft for a couple of implants and they say that I need to get some other work done before doing the implants. They told me that I would have about 1-2 years before the bone graft wouldn’t be strong enough to support the implants. Is this true? Is it true that there’s a time limit as to how long the bone graft is able to support the implant?

    Reply
    • Hi Jordan,

      Most bone grafts heal in 4 months. Some people need more than one graft if their situation is complex. Occasionally a complex graft will take 7-9 months, but those are uncommon.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  329. Dear Sir,
    If the donor bone is taken from jaw or chin area can this area be used again in future for furthur bone graft? For example, after several months when the donor site is healed could the bone from this healed area be taken again?

    If synthetic bone graft fails does it mean the patient can never have that kind of synthetic graft anymore?

    Reply
    • Hi Saad,

      Nothing is absolute. You can re-graft and re-harvest areas that have been used for donor bone graft sites. It is a bit more complex though. Better to have it done right the first time.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
      • Dear Sir,
        Thanks for the reply. Actually several times it is seen that an implant might come out after few years. Also, bone grafting might need two tries when done first time. If the donor bone is already taken two or three times can it be furthur used after few years when the implant fails? I mean is there anything like a “number of times” a certain donor bone can be used or does it grow back to its original shape and form after sometime and can be reused over and over again.

        If synthetic or bovine graft fails does it mean the body has rejected the graft and that particular person can never have graft from these materials?
        Actually, I am very healthy. However, I am missing several teeth and I am pretty young. I read news like xenograft has 75% success rate. So, it worries me thinking that there are 25% people who cannot have bone graft.

        Reply
        • Hi Saad,

          It is not the bone that has a “75% success rate.” It is the technique, skill and expertise of the surgeon in placing the bone graft and your ability to heal. It sounds like you need someone more concentrated on implant dentistry to take over your treatment. You should also have a medical evaluation.

          Respectfully,

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

          Reply
  330. Is it possible to do a bone graft on a good tooth? I have lost bone around the gum line and is prone to infection.
    It is the last tooth upper left. My dentist would like to pull the tooth.
    I have had only one infection.

    Reply
    • Hi David,

      Not all natural teeth can be bone grafted. They have to have a certain pattern of bone loss to be able to be grafted predictably. I would have to see you to answer this.

      Dental implants and teeth follow
      different sets of rules for building bone.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  331. I have implants in front lower jaw, with bone grafts. I am 66 years old. What can I do to help insure that these grafts will grow? Can I or should I take supplements. I take vitamin D daily . Should I take Strontium bone builder? Also I sleep in the temp teeth..they said I should keep this covered all the time..I have clenched my teeth most of my life should I let them know or wear some sort of drugstore appliance to protect the implants. I have two more months before I am scheduled to return to my dentist. Thanks You for any information. Your site has been helpful.

    Reply
    • Hi Judith,

      You should see your dentist for clarification. If the temp teeth are removable, I advise most people just the opposite…take the teeth out when you sleep.

      Clenching and grinding forces are detrimental to healing dental implants.

      If they are fixed temps, don’t chew anything solid on them.

      There are no special bone building supplements. Eat right, don’t smoke or drink, and maintain a good weight. These will prevent most health problems.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  332. Hello, I had 3 impacted wisdom teeth last week, as well as a molar that never grew in all the way. they did a bone graft on the molar. I did not get an implant because ive never had a full tooth there any way. So that was 8 days ago, they did not prepare me for the severity of these procedures. After 4 hours AWAKE thru the procedure ( apparently they could not get the teeth out) I walked out in sever pain and the swelling was outrageous i looked like elephant man. They did say all teeth were extremely difficult to get out, but im still very swollen and the pain has gone down but still pretty intense. I can not talk without a serious slur, I can not chew, i can not open my mouth more than 1/4 inch , my cheeks still look like chipmunks and they are yellow…. Is this normal, im known for being a tough girl pain does’nt bother me much , but this seems a little over the top and its been 8 days they said it would go down by now.
    thank you for your time

    Reply
    • Hi Auberon,

      How are you doing now? Sorry for the delayed reply.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  333. Hello Dr. Amin. After viewing your video on block bone grafting. i can say that i will be needing one of these for my right upper front tooth. The entire outer aspect of the bone for that tooth is gone and the tooth can be pushed forward to the brink of falling out. The tooth to the right of this tooth is also very loose as well. Can the tooth that still has bone on the outer aspect be saved with other types of bone grafting? On the other front tooth. it moves some but is still strong but most of the ridge between both upper front teeth has receded. I will need scaling and root planing for my front lower teeth as well to eliminate the periodontitis infection that is down there as well. all of those teeth do not move. When someone has periodontitis, does the diesease have to be took care of before the block bone graft can take place? will i have to run around without a tooth and the bone graft until the disease is took care of? After the block bone graft, flap surgeries and whatever else i will need, how long can i expect to get a flipper to replace to the missing tooth? I know these are alot of questions but just so many concerns. Thank you for your time

    Reply
    • Hi Brian,

      The other loose teeth may tighten up after the gum treatment. You will have a temporary tooth during the bone graft. It generally takes 8-12 months to complete.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
      • Hello Dr. Amin. I have undergone a periodontist’s treatment plan. I took antibiotics to kill the underlying periodontal disease and have also had all 4 quadrants completed with root scaling and planing along with the laser treatment. I consulted with anothrer dentist to have a second opinion and she believes that since i have one tooth that has completely came out on its own because of the amount of bone loss, have another that is extremely lose do to bone loss and two others that have catagory 1 movement with slight bone loss that all four of my front teeth need to be removed and a double block bone graft be completed to place four implants for a four crown front bridge. My periodontist said that after my 6-week eval that will pull the teeth needed to be pulled and place with a flipper so i will not be leaving the office with out missing any teeth. When the time comes to perform the double block grafting, will i be able to use my partial denture or will it need to be adjusted so that it does not impact the surgical sites. Thank you SIr

        Reply
        • Hi Brian,

          Yes, you will be able to use the temp during healing. Keep in mind that if the temp rubs the gums during the first three weeks the stitches will open and expose the bone. This is not a good thing!

          Your dental implant surgeon will need to release the tissue for the block graft to fit. Why the block grafts though? Have you been given other alternatives such as bone expansion?

          I am not against block grafting, but there are many other less invasive methods that work so well. Sometime the block is the only way it is possible though.

          Good luck,
          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

          Reply
          • Hello Dr. Amin.

            My upper front right tooth has completely came out because the front wall is completely gone and the gums have grown into the socket which has casued the tooth to move forward and detach from periodontal ligament. My left two upper teeth do have some bone loss as well and move somewhat but do have alot of bone left. The general dentist recommends that all four front teeth be replaced with implants because there is no way to fill in the gaps where the gums have receeded and to make the single implant match the rest of my mouth. im just frustrated because i have had this going on the last 3 months and i am ready for the partial so that i can be comfortable smiling at people again and not have to worry about people staring at my teeth and asking me whats wrong. Was hoping the necxt visit would be a impression for the partial but it is only going to be a follow up of the root scaling and planning that was done. im ready to move on!

          • Hi Brian,

            Based on what I hear I would probably agree that the other teeth would need to be extracted too.

            You should be able to have the implants done on the same day or 3-4 months after extraction.

            You should have a temporary the whole time ! You should never be without teeth during the dental implant process.

            It sounds like you and your dentist need to review your plan. There must be a reason for the delay.

            Ramsey A. Amin, D.D.S.
            Diplomate of the American Board of Oral Implantology /Implant Dentistry
            Fellow-American Academy of Implant Dentistry

  334. Good evening Dr Ramsey. I had a tooth pulled (lower right jaw) a week ago and the dentist put in a bone graft and stitched me up. In the last two days all my stitches have fallen out and I can see something in the hole that has a bunch of little dots. Is that the graft? And am I supposed to see that and/or should I contact my dentist? Thank you in advance.

    Reply
  335. Three weeks after dental implant I have pus coming out of the area….I can’t see a dentist until tomorrow….what do I do in the meantime?

    Reply
    • Have the dental implant specialist call you in some antibiotics ASAP. This is a the reason I give my patients my cell number if they have any issues.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
      • Hello Dr. Ramsey. I know i have a serious form of periodontal disease around my right front top tooth. Both the front tooth and the one next to it are lose. my gums above my teeth used to be really red so i started brushing and using mouthwash. I can tell on gums that i can see have returned back to the normal pinkish tint, but my front tooth is not fully exposed on the visible side. and is extremely loose. I do believe it will need to be remove and a block bone graft put in its place to rebuild the bone and prep for a dental implant. Can you let me know if i am on the right path of my diagnosis and could you give an estimated cost with and without dental insurance. Thank you sir.

        Reply
        • Hi Brian,

          It is very difficult for me to guide you with such limited information. I would really need to see you and take some x-rays.
          Cost range is likely to be $3-7k.

          Respectfully,

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

          Reply
          • Thank you sir for responding to my question. i have done more research since my last post. The entire front wall of my tooth is gone all the way up. Can the tooth that is loose and still has plenty of bone be splinted to the one next to it so that the particulate bone will grow back new bone and stabilize the tooth? I do need to get the periodontitis under control first i know but after the front tooth is extracted about how long would you think i would need to wait to get a flipper for cosmetic appearances and when i could get the block bone graft? i just do not want to go more than a week without a missing tooth. That is my biggest fear.

          • Hi Brian,

            I make flippers for patients on the very same day of the extraction so they never go without a tooth! There are other better options than a flipper such as an Essix. The temp is CRITICAL during a block graft!

            Respectfully,

            Ramsey A. Amin, D.D.S.
            Diplomate of the American Board of Oral Implantology /Implant Dentistry
            Fellow-American Academy of Implant Dentistry

  336. Hello I’m writing in regards to a bone graft I received two weeks ago today. I’m 29 and received a root canal on tooth #30 when I was roughly 15. Recently I began to notice breakdown of the gum line around the tooth and would notice that infection would set in (the area would get red and raised) I went on antibiotics, finishing them up before going to the surgeon to get the root canal/tooth taken out. I was told that a dental implant would be the best option for me. In lieu of choosing the option of implant I was told I would initially need a bone graft. So I received the bone graft with the implant coming up probably within the year (have to gather the finances). Now that I’m two weeks out I’m still noticing minor issues such as moderate pain in the area, the tooth in front of it (another root canal tooth) and the molar behind it feeling “off” or even sensitive to particular things. But then again could it just be the graft area that I’m feeling? I’m aware that pain can be felt between teeth rather than at the source. What is the turn around time for healing, my greatest concern is the possible failure of the other teeth around it. I get a “floating” type feeling, or even a nagging (sorta of a throbbing) feeling at times when I bend over, become really active or even jump. Is this normal? That’s my chief concern, I also have noticed that coffee seems to have adverse affects on how my mouth is feeling. Any help would be great… last thing- the tooth was very infected and the surgeon had a very difficult time taking it out due to how broken down it was and had to actually cut away at the surrounding bone which caused the need for a bone graft. Is all that I’m feeling normal? This is the first bone graft I have ever had. Again I appreciate any help you could give.

    Reply
    • Hi Lance,

      What you are experiencing may not be normal. After about 1-4 weeks most grafted areas have no symptoms.

      It really sounds like you might have issues with the surrounding teeth. I would suggest you get them looked at ASAP.

      Without seeing you personally, it is difficult to tell you anymore.

      Sorry. I hope this helps you. Don’t give up!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  337. Hi Dr. Amin,
    A week ago I had a bone graft on my front tooth, they also took some tissue from the roof of my mouth to build it up because I had very little gum tissue. The dentist said I wouldn’t be able to eat normally for another 5-6 weeks. All the stiches are out and it’s sore but I was looking forward to eating normally instead of applesauce and pudding. What foods would be okay to eat? What should I strictly avoid? Can I have sandwiches or pizza?
    Thanks!
    Caitlin

    Reply
    • Hi Caitlin,

      Avoiding pressure on a bone graft for dental implants is very important. Until you see your dentist, dont eat anything that you can’t squish with your fingers. Pasta, boiled chicken, soups, flaky fish, etc are all good choices.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  338. Hello, five days ago, I had bone grafting and dental implant for teeth #7 and #10. They were baby teeth with no permanent teeth behind them. I have several questions.

    Question 1:
    The areas around the bone grafting and implant are still slightly swollen. I can see the silver-like screw in area #7, but I can’t see the scew in area #10. I have basically stayed on a liquid diet since having the procedure in fear the implants will come put. Because I can’t see the screw in area, does that mean it has come out, or could it be due to swelling? I go back to see my oral surgeon in two days to have my stitches removed. I was just hoping you could offer a small piece of mind until then. 🙂

    Question 2:
    A certified oral surgeon who specializes in this line of work performed the grafting and implant procedure; however, I was referred to my family dentist several weeks before the procedure to have impressions made for an Essix retainer to disguise the two missing teeth. The surgeon wrote “Essix Appliance” on a prescription tablet for me to take to my dentist. In turn, my dentist did NOT make the Essix. He instead made me a flipper. My oral surgeon advised against the flipper due to it may cause the implant to fail. He said Essix was better. I have an appointment withy dentist this afternoon to go over the correct piece: Essix. I am worried, however, and somewhat panicked (I have two missing front teeth!) that he will try to take new impressions and cause my implants to fail. Can the Essix be made with the same impressions molds I had done before the surgery? Also, I’ve been doing quite a bit of research on this, and I have read that an Essix can be difficult to get a perfect match. Is this true? I am worried because I need it to disguise the two missing teeth.

    Any info relating to these questions will be most helpful. Thank you!

    Reply
    • Hi Alisha,

      The fact that you can’t see the screw has no bearing at all. It is not an issue.

      An Essix temp is great but they are fragile. The impression can still be made for a new one even though the implants are already in.

      Everything you described sounds normal. Good luck.

      Dr. Amin.

      Reply
  339. I wanted to say thanks for this information. I was told Friday I needed an additional bone graft for #25……I’m happy to see sometimes this is needed, and this is the only website I have seen it on!

    Reply
  340. I had a bridge on 13,14,15. The bridge’s procelain chipped and the bridge removed, in doing so ti was discovered 15 was decayed badly. So 15 was extracted (14 and 16 extracted 15 years ago) and temp crown put on 13. An oral surgeon did the extraction and the same day did a bone graft on 14 and 15. During this, the temp crown on 13 came off. It was cemented back on after the graft was done, same day. During the procedure, he said he noticed that there were bits of bone from 14 still in my gum and he said he tried to work them out but only an x-ray later on will tell.
    My questions are:
    1) Sutures go from behind 15 to 13. 13 ha two sutures, one before and one after it. Between the two sutures, on the inside of my mouth is a tiny speck white dot protruding from my gum (not the cheek side). Is this a piece of bone left possibly from 14 OR is it a piece of bone graft material working itself out through my gum?
    2) A mesh was placed over the graft site. When that is removed (probably in 4 weeks), is it possible that pieces of the graft material may still come out (as I read is normal)?

    Reply
    • Hi Chris,

      This all seems within the normal range. Without seeing you in person it is very difficult to try to asses this for you.

      Sorry.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  341. My daughter had bone graft/implant surgery six months ago. She had to have surgery again and the doctor said that the bone was decayed. Why would it decay at six months?

    Reply
    • Hi Tracy,

      The word decayed is a bit strange. Are you sure this is the word the doctor used? My guess is additional bone volume is needed and or the graft shrunk.

      Sometimes you have to build bone back in stages rather than in one fell swoop. Just because bone is placed in the area doesn’t always mean that it will take 100%.

      Sometimes it only grows 80% and the other 20% needs to be added at a second procedure. Our bodies all respond differently!

      I hope this helps!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  342. HI Dr. Amin
    I had four bone grafts done on my teeth at the end of November ….all of the teeth are on the lower right side of my jaw. I don’t have the exact numbers, but two are closer to the front of my mouth and two are at the back…there is a gap between these sets of a tooth that was pulled many years ago. So far, everything seems to have gone fairly well up until now. The gum over two of the bone grafts (front) have closed over the membrane as they should…the back teeth have taken longer to heal but shows signs of beginning to close slowly in the last few days – however the membrane is still clearly visible. Is it normal for the gums to take longer to close on the bigger teeth in the back? Also, it looks like there is a sliver of bone graft coming through the gum at the top of the biggest tooth above the membrane. Right now it seems to be pushing through the gum itself at an angle. Is this something that will come through on its own or do I need to see a periodontist to have them remove it. So far there is no pain or swelling around it but there is a little bleeding when I swab the area with peridex. My regular periodontist is out of town until the 11th and I would need to see her emergency backup before then.

    I do not smoke or drink at all and have a temporary flipper over these teeth to protect them. I have been chewing on the other side of my mouth…is it possible that the motion would aggravate the surgical site on the opposite site? Since my gums have stopped swelling, the flipper no longer fits as tightly as it used to.

    Reply
    • Hi Dawn,

      Sometimes a membrane is purposely left exposed. This would be common in a “socket bone graft.” In other types of grafts, membrane exposure would be a bigger problem.

      It is not uncommon to lose some particles of bone from the top of these types of graft. I am assuming this was not an onlay block bone graft. Your dentist will likely remove them.

      Don’t wear the flipper! If you don’t need to wear it. They can cause major complications!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
      • Hi Dr. Amin
        Thanks for your explanation. It was a socket bone graft so I am relieved that this was normal. I went to the periodontist on Friday who said everything was healing normally…what I thought was a bit of bone peeking through the gum was actually a bit of the membrane so they removed it as it was beginning to fold over at the top as well.

        Unfortunately, due to the original design of the flipper (full mouth) and some extensive tooth loss I have to wear the flipper. Do you have any suggestions at all to help with making the flipper safer to wear? My primary dentist suggested putting a small piece of gauze under the ridge of the flipper so that it does not rest directly on the gum.

        Thanks
        Dawn

        Reply
        • Hi Dawn,
          The flipper should be relieved to have a bit of space and/or a cushion reline material if possible.
          Good luck!

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

          Reply
    • Hi Boyan,

      Usually the lateral window sinus bone graft for implants has a longer course of antibiotics than the internal method. One to two weeks is normal. I hope you are healing up well now.

      I have been doing sinus bone grafts for more than 10 years and they very successful when done properly.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  343. Hi Dr. Amin

    I had a bone graft surgery in the sinus area 2 weeks ago. All seemed fine until 2 days ago when the area swell, although I didn’t feel much pain. My dentist put me on a 4 days co-amoxiclav course, but I’ve read that the usual antibiotics course for a graft infection is 14 days. I am now in the third day of taking antibiotics and the swelling subsided a bit, although not completely gone. Should I seek the second opinion on the length of the antibiotics course?

    Thank you so much.

    Best regards,
    Boyan

    Reply
    • Hi Boyan,

      Did you have a lateral window sinus or did you have an internal sinus lift bone graft?

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  344. Hi Dr. Amin

    I went for bone graft surgery 6 and a half weeks ago following the removal of a radicular cyst and tooth extraction in my upper jaw. The bone material used was bone granulation or bone sugar as my surgeon calls it. My surgeon says I must not smoke at all during the 6 month healing process….but I read earlier in these posts that I must wait a month after surgery. Can I go ahead and continue to smoke or should I take my surgeon’s advice? Another question I wanted to ask is at this stage in my healing process…has the bone started to form yet?

    Thank you so much

    Kind Regards
    Brendon

    Reply
    • Hi Brandon,

      I would do what your surgeon says. Bone is already forming in its infant stages and smoking impairs bone healing. Do your part to increase the chances that this will work for you.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  345. Dr. Admin,

    I had a tooth extraction (31)and bone graft on the same tooth 7 days ago, and I am still experiencing a lots of pain. I am taking amoxicillin 500 mg and ibuprofen 600 mg. I had swelling for 4 days, and is going down now, but the pain is still there. I cannot go without ibuprofen every 8 hrs. Is this normal? I am concerned about non stop pain unless under pain killers. Thank you so much.

    Reply
    • Hi Mimi,

      Your pain is likely from the extraction NOT from the bone graft.

      You may have a dry socket or an infection. I can’t speak for all dentists or situations but the majority of my patients tell me they had little to no pain after bone grafts and extractions.

      Were you given IV steroids?

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  346. I have been told by my dentist that 3 teeth will need to be taken out and i will need to have implants to replace them. I thought i would have time to research everything that needs to happen but alas my teeth have actually started aching and need to get them pulled pronto. I will not be able to do the extraction and bone grafting at same time due to finances. Is it possible to have the extractions done now and then after a month or so have the grafting done? Will i have already lost too much bone in that time?

    Reply
    • Hi Diane,

      The bone graft, if needed, can be done later. Building back bone in stages is very common and in some cases the preferred method. Sometimes the graft is done at the same time as the extraction or implant.

      It all really depends on your unique situation.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  347. Hi,
    I am going to have my bone graft done 2 weeks later and my surgeon told me that he will only know whether the bone graft is success or not after placing the implant. This is really surprising because I thought he should be able to know by taking x-rays in the early stage but not during the implant procedure, right?

    Thanks.

    Reply
    • Hi John,

      In the early stages the X-rays will not show you success. What it looks like in real in the first few weeks is a better indicator for a bone graft for dental implants.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  348. My dentist wants to perform a root canal on tooth #31, & on the same day do a core build up, crown lengthening, place a perio membrane, apply Arestin, & do a crown prep. He says it will only take about 90 minutes. Can all of this be successfully done in such a short time on the same day? I had another dentist years ago who did a crown & root canal on a molar & he had me come in for several appts. because there were 3 canals & he wanted to make sure the tooth wasn’t going to act up & the root canal would be successful. Please advise because I don’t live far from your office, & I’m not sure this long, drawn-out process can be done in one sitting(with a return for the crown to be delivered.). Thank you in advance because I’m really uncertain.

    Reply
    • Hi Elizabeth,

      Wow, that might be a bit bold to do all in one day. If a membrane is involved, healing time needs to elapse.

      I would recommend doing one step at a time. Why rush treatment on your body parts?

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  349. Hi Dr. Amin,

    I am a uni-cleft lip/palata patient who underwent bone graft from the hip to the upper jaw (cleft area). This is about the 3rd graft done. 1st one was from hip, 2nd from chin, and 3rd again from same hip. My last surgery was in 2007 with bone taken from chin and upper jaw moved forward. Didn’t go as expected and maxilla or rather the teeth were slightly mobile (meaning you can take your fingers and try to shake your upper front teeth and will notice a tiny mobility). Eventually, OMS said to to remove left incisor and canine (which was done last year), let area heal, and do bone graft in order to to do implants. Surgery was done on November 14th. Recovery seemed to be fine until I met OMS yesterday and he said everything looks good except he didn’t like how the bone was exposed a bit (said that it had opened up a bit). So what we can see was “white part” near cleft area which was bone with gum around it. He said not a big problem and gum should brow over it eventually but he suggested we stitch it back together. Local freezing done at his office and he put some nylon stitches to partially close it off. It looks to me like I can still see the white part but there is a lot of stitches around so it is hard to tell. He prescribed apo-clindamycin to prevent infection and peridex for oral rinse. He mentioned to keep area clean and this is not uncommon. He said what we see is about 1/5th of the bone he put it. I am so worried as this was a big surgery and don’t want any problems. Does this sound normal to you ? Any help appreciated.

    Reply
    • and also will the gum grow over that bone over time? anything i can do to help blood supply to the area in order for things to start growing over and healing?

      Reply
      • Hi Balraj,

        A cleft is very difficult to deal with. Bone should remain covered while it heals. Exposed bone will typically die and need to be removed. The more surgeries you have in the area, the more scar tissue develops. It is a double edged sword.

        Ramsey A. Amin, D.D.S.
        Diplomate of the American Board of Oral Implantology /Implant Dentistry
        Fellow-American Academy of Implant Dentistry
        Burbank, California

        Reply
        • thanks for the response..will the gum not grow over that bone, my OMS mentioned to keep infection free by keeping area clean and gum should grow over it ? i had similar procedure back in 07 when bone was exposed a bit like this as well and they usually just scrape it off. When you say remove, will that mean another huge surgery while being knocked out? do you recommend to keep grafting or possible move over to dentures/bridges, what would you suggest is best (least problem free down the road) solution to this?

          thanks again

          Reply
          • Hi Balraj,

            Scrape and remove will mean the same thing if the exposed bone is limited to a small area.

            Ramsey A. Amin, D.D.S.
            Diplomate of the American Board of Oral Implantology /Implant Dentistry
            Fellow-American Academy of Implant Dentistry
            Burbank, CA

  350. I had particulate bovine bone grafts (mixed with a small amount of bone bond) done on teeth 2-5 and 9-12, not to prepare for implants but because there was significant bone loss (especially on 2-3) and I wanted to stabilize the teeth for the long term. Three months later, there is no sign of bonding material or bone growth in digital xrays. Does that mean there will be no bone growth? I am getting conflicting answers from the original surgeon and another oral surgeon I consulted. The original surgeon says the type of xray makes a difference, digital being better because old style xrays can slow or halt the growth of osteocytes. The consultant says that is not so, and that if there were bone graft material or bone growth at all, it would show up in the xrays. He feels that the surgery is a failure. I’m not sure who to believe. Thanks for your help.

    Reply
    • Hi Barbara,

      Three months for your type of bone graft is too early to tell. It sounds like you had grafting to save your existing teeth.

      Some bone shows on X-ray and some does not. The X-rays are not going to kill the bone cells. That is information that is 30 years old.

      The most important thing is did the bone graft eliminate the pockets? Do the pockets bleed when they are measured anymore?

      Give it time and check back with me in a few months.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  351. Hello,

    Yesterday I have had my second bone graft and I am experiencing unpleasant oddorly drainage. I am on penicillin and prescribed mouth rinse. Is this odor normal?

    Thank you.

    Reply
    • Hi Liliana,

      You should see your dentist ASAP to determine this. Some people get temporary bad breath after oral surgery but drainage is typically not a good thing.

      Good luck.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      Reply
  352. I have moderate osteoarthritis and am 71 years old and would like to get a molar implant but I need a bone graft first. How much do these two factors increase the risk of a bone graft rejection?

    Reply
    • Hi Glen,

      Arthritis is usually not a factor unless it is a the rheumatoid form. Osteoporosis is a much bigger deal.

      I wouldn’t let it concern you. Go ahead and have the bone graft and implant.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  353. Hi,

    Had a bone graft after an extracted tooth on my lower jaw on Friday afternoon, it is now Sunday night, and the stitches are coming loose…. what should I do?

    Thanks

    Reply
    • Hi J,

      Sometimes this is normal. If the area was swollen and is now decreasing in swelling the stitches will loosen by default. You will probably be fine.

      Most times I put many backup stitches in case one becomes loose. Having a few extra is a good thing.

      Also suturing technique by your implant dentist is critical over bone grafts. Usually a vertical or horizontal mattress is the method of choice.

      There are also many different types of stitches. Some are weak and dissolve on their own in 3 days while others last 3-4 weeks.

      Suture choice is very important.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  354. I had a bone graft one month ago in my lower side but i dont see any difference my teeth are the same than before the surgery….Do you think. I have to redue again? please help me!!!!!!

    Reply
    • Hi Dorisa,

      Not all bone grafts make a visible difference on the outside of the gum. Many are internal and within the bone.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  355. I believe I will need a bone block graft for posterior mandible region for later implant placement (first and second molar) I could also use braces but it’s not absolutely nessicary (could just do a partial treatment to intrude slight super erupted molars) if I get full braces will that complicate the bone graft procedure, since my teeth are slightly crowded and it might move into space some i would imagine.. Should i get full braces before and after block bone graft and how long after…if after..

    Reply
  356. Had sinus lift one week ago and still bleeding a little bit. Feel a little throbbing. Went for checkup with periodontist and he said bleeding is normal. Is that right????

    Reply
  357. What is the average cost for bone grafting? I recently paid $800 for tooth number 10.
    Does that sound like a good price?

    Reply
  358. Hi Dr. Amin,

    I had a bone graft done in the front and back of my chin area (from canine to canine) 2 weeks ago. In my first post-op, there was no gum recession, and the periodontist said I was healing really well. However, there is noticeable gum recession in the front now. Will the gum possibly grow back to cover the receding area as it heals more?

    I will really appreciate it if you can answer this question. I have been very paranoid about the gum recession.

    Thanks a lot!

    Reply
    • Hi Karina,

      Often times the gum is purposely positioned really high after the surgery. This is often done in anticipation of normal contraction of the gum flap. As long as the bone is not exposed, it may be normal. Your dentist will take good care of you.

      Dr. Amin

      Reply
  359. Dear Dr. Amin

    Many thanks for your quick reply. I do appreciate this.

    I have read that if there is a problem still within 3 months, surgery can be done to re-connect the damaged nerve. Is this possible?

    Also, may I experience the same numbness and possible long term complications when I go ahead with the sinus lift and dental implants?

    I am so nervous now, that I may not go ahead, but I will be left with upper temporary teeth on my upper jaw. I may even consider, having everything removed and a denture placed as a last resort.

    Thanks
    Kim

    Reply
    • Hi Kim,

      Yes, it is possible. Although uncommon, there are risks and complications that can and do occur with dental implant surgery.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  360. I am so distraught! I lost #8 at 13 yrs, and then had an implant placed in 2002. I was too afraid to proceed, so I didnt attempt to have the crown completed until 2008. It was VERY unsucessful. I was told the the implact was placed too facially. Since then, I have gotten 2 infections in #8 and recently I (3 days ago) I had a graft done.

    My issue is whether or not I will be able to achieve an aesthetically pleasing final restoration? Would a custom abutment be of any help? I mean it’s #8…DEAD SMACK in the front. Honestly…the flipper looked better to me! Perhaps I had just gotten used to it.

    I miss being able to smile.

    Any input would be appreciated.

    TCF

    Reply
    • Hi TCF,

      The delay of 6 years probably is adding to the difficulty. Have they considered removing the entire implant and starting over? Sometimes bone lost around an existing implant is hard to rebuild. I try to put a lot of extra bone on the outer wall to make the bone stable for the long term and tilt it towards the tongue a bit.

      Are you local enough for me to look at you to see if I can help?

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
      • Good Evening Dr.Amin,

        I really wish I was close to you. I’m in Boston. I just want to get this taken care of. I do have a quick question….if the bone is successfully regenerated, what would you suggest be the next step to a nice final restoration?

        Thank you so much

        TCF

        Reply
        • Hi TCF,

          Without seeing you, this is a question that can not be answered precisely. The next step should be to follow the treatment that your dental implant dentist has developed.

          Sorry!

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry
          Burbank, CA

          Reply
  361. Hello Dr. Amin,
    I had an extraction, dental implant and bone graft of my left upper canine performed 7 days ago and during hygiene this evening the stitches came loose and fell out. Now the area where the stitches were tightly tied has a “horseshoe” look to it where the gum is not fully together. You can see the metal of the implant as well. I emailed the Dr. who performed the procedure as well, however seeing that it is a weekend, I am doubtful to get a response. Is this an abnormal healing response?
    thank you,
    Amanda

    Reply
    • Hi Amanda,

      The stitches they used probably are supposed to dissolve after 7 days. It is not uncommon to see the implant after it is placed. It sounds normal!
      Was the plan to bury it for some extended time period?

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  362. Dear Dr Amin

    I had a bone graft done a month ago on the left upper side of my jaw, and everything seems fine up until now.

    One week ago I had another done, on the right upper jaw this time I still have numbness on my chin and swelling around the lower jaw, although no pain.
    How long does it take for the numbness to go and should I be concerned yet about this?

    Also, the dentist says that I need a sinus lift on the right upper jaw and will do that when he places the implants in 6 months time. Is this correct as I have read that implants cannot be placed for several months after a sinus lift has been done,

    Many thanks.

    Kim

    Reply
    • Hi Kim,

      Be sure to talk to your dentist about the numbness. It sometimes happens, even on the upper jaw.

      The implant and the sinus bone graft lift CAN be done at the same time in the hands of a very skilled dental implant dentist. It depends on how much bone you have naturally.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  363. I had a bone graft after my upper molar extraction a month ago. Everything seemed to be healing well until this past week or so. I have these very sharp fragments (6-8) of bones? protruding from my gum ridge. The pieces literally cut my finger when i touch them. I’m also tasting slight pus. Is this normal? Please advise. Thank you in advance. Pj

    Reply
    • Hi PJ,

      It sounds like you have a socket graft that is slightly infected. This is not uncommon and can be easily treated by your dentist as long as your immune system is functioning well!

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  364. Hi Dr. Amin,

    I just recieved two bone grafts on Wednesday in preparation for dental implants, I’m congenitally missing both my lateral incisors. Everything seems to be going well, little to no pain but the membrane is peaking through slightly on both sides… Is this normal? Also, my flipper no longer fits, is this due to swelling or have my teeth moved? I haven’t had it in since the graft, if its due to swelling, will i be able to wear it in a couple days? Thanks for your time!

    Reply
    • Hi Jessica,

      I would advise you not to put the flipper back in until you see your dentist. Pressure from the flipper can cause failure of the graft! If the membrane is a dissolvable type, it should be fine although we prefer it to stay covered.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  365. I had my lower right canine removed last month at which time they also found and removed a large cyst. The tooth was dead. Now I have a large hole there and the flipper doesn’t cover it. I think I will do the bone graft soon but then leave town for 3 weeks. Will I be in much pain? Do sutures need to be removed? Can I wear the flipper after the bone graft? This is all so overwhelming. I will be 60 this year. Thank you.

    Reply
    • https://www.burbankdentalimplants.com/how-to-choose-an-implant-dentist/

      Hi Debbie,

      The unknown can be a bit scary!

      The timing of the bone graft is best determined after examining the type and location of the bone defect. Usually sutures that dissolve are used. Pain really depends on the difficulty of your unique procedure and the skill if the implant dentist.
      You can wear the flipper during the whole process, just dont sleep with it in.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  366. i had a bone block grafted on my upper left canine and right lateral incisor a week ago, my gums are are now healing. but the gums on my lateral incisor were stitched tightly, it is stretching when im smiling or laughing and it hurts a little, will it go back to normal?!

    Reply
    • As long as the gums stay closed, all should be good. What you are experiencing is normal. Keep me posted!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
      • thanks for the reply.
        im now on my third week of healing and i noticed last week that the bone is sticking out of my gums?! is this a sign of bone rejection? how early to tell if it’s a bone rejection? my dentist is not so cooperative as she is due to deliver a baby soon. im thinking coz the sutures were accidentally removed on my second week when i was gargling so the gums was quite open and healed open so the bone was exposed. but right now, it is not swollen and not hurting.

        And also, on my canine part heals fine, but I noticed that I can see through the gums the screw of the bone. Is this also normal?

        Reply
  367. I had an extraction with bone graft done the same day on a top back molar. It was three weeks ago, and still have moderate to severe pain in the area.
    The pain comes and goes, but when it pulsates in it is almost as bad as before the tooth was pulled.
    I’m due to see the doc. in two weeks for the ‘4-6 week check up’. Should I wait till then and hope it heals up and feels better? Or should I be more urgent about the matter and get an emergency appt. with him before then?
    I’m afraid of jaw infection and spreading to other teeth. The first two weeks I took pain meds and was fine. Now three weeks in the pain is still there. It seems healed and closed off, and the pain is coming somewhere from within the jaw bone…. Thank you for any help in this. Its 2am and my dentist is out of reach….

    Reply
  368. Dr. Amin
    I am missing #2 and #3. The Periodontist who evaluated me said the ridge is deficient in both vertical and horizontal dimensions. He recommends split ridge augmentation and implants. He plans on using cadavrs material for bone graft.
    I am 66 years only and have severe osteoarthritis (hips and knee). he estimated 12-24 months to complete.
    I am very nervous about the risks involved in going forward with the bone graft and implant.
    What are the risks of doing nothing.

    Reply
  369. I had a tooth extraction and a bone graft done a couple days ago and it’s very painful and I’ve been having a foul taste in my mouth from it. I’m on antibiotics right now because of an infection that was present before the tooth was extracted. He has me on cephalexin. Is the bad taste normal? If so, how long before it should be gone? Also, would having a bone graft done right after an extraction make the healing process quicker or longer?

    Reply
    • Hi Chelsey,
      The bad taste can be from an infection or it could be a side effect of the antibiotics. What did your dentist say?
      Having the bone graft and the implant on the same day, usually shortens the procedure time.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  370. Dr. Amin,
    I had a bone graft and immediate loading at the same time done 2 days ago in both side of my upper No. 1,2 . my dentist recommend to do the bone grafting for a better result of my dental implant, since my gums were shrunk and the bone is thin. now i don’t feel pain even after the procedure but my face is still swelling is it normal? i inform my dentist regarding this matter but he said that it will occur 3 to 4 days because of the bone grafted. thank you!

    Reply
    • This sounds fairly normal.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  371. The peridontist thought the same thing !! And he has said to leave it for another few weeks and if it does not subside then he will refer to me to doctor specialising in dental nerves etc. Thanks for your help.

    Reply
  372. Thanks for replying Dr Amin. When I had the implants fitted, it was left for a few months for the bone to fuse to it. Everything was perfect. No numbness was felt in that time at all. However, weeks after the actual crown was fitted, one of them become lose, the gum was very inflammed and it was impossible to eat on that side. In between going back to the dentist for him to address the inflammed bleeding gums and discomfort, that is when I started to feel the numbness, well it’s more of a frozen feeling and it is just in the implant area not the whole side of my mouth. It has now been 4 weeks since the bone graft, it is healing nicely but the frozen feeling is STILL there. At very odd times, it feels like the numbness is subsiding and funny enough the numbness is less pronounced in the morning. Do you think that as time progresses and the bone hopefully grows back that the frozen feeling will go away ?? It’s just two weeks ago, the dentist was slightly concerned that I was still feeling numbness. By the way, the other implant has never given me any problems at all.

    Reply
  373. Dr Amin, an additional question to my last one above (Jestina). The peridontist said that after the bone graft, i should experience swelling approx 3 days later, he offered steroids which I duly accepted. The dental nurse gave me four tiny tablets of 5mg or 15mg of something. Do you think that in taking the steroids, it had a negative effect on the graft ‘taking’ ? I know it seems a silly question to ask but although I was in agony after the bone graft, I experienced no swelling. I now fear that the bone graft was useless, the bone won’t grown back so I can’t have the implant reinserted but worse I am left with the numbness in my jaw which feels like a ‘freezing’ effect. I’m devastated with worry.

    Reply
    • Hi Jestina,

      It sounds like everything was done properly including the steriods. Did the numbness happen after the crowns were put in, or after the implants were put in the bone? This will help me to help you.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  374. In March 2005, I had two implants either side of my lower jaw to replace two molars, three months later the crown was fitted. Literally, within weeks, the crown became loose on one of them and the gum around it was red raw and extremely painful. I went back to the dentist; he screwed it in, which surprised me. I thought he would have removed it and treated the area. Ever since, I have had constant problems. The main one being a feeling of numbness in the area. I can only describe it like the feeling you get when a dental anaesthetic is wearing off. This has gone on for years. The dentist burnt off some of my gum, that didn’t work. Six monthly check ups and x-rays found nothing but he mentioned peri-implantitis . Two years ago, he removed the crown and I believe treated the area with citric acid. Nothing worked. I continued to suffer numbness and sporadic bleeding of the area when I brush my teeth. I asked for a referral a few weeks ago and a peridontist identified pus, bone loss and implant failure. He removed the implant and did a bone graft. Two weeks after the bone graft, I am still experiencing that feeling of numbness. I am now worried that the bone loss is irreversible and I have to spend the rest of my life with a numb jaw, which whilst it is not painful just doesn’t feel normal. Can you help ?

    Reply
  375. Dr Amin,
    I had a block bone graft done along with a gum implant on the front upper part of my mouth. Unfortuantely the suture popped and I had to have another surgery, and the doctor removed the bone graft and replaced it with a synthetic material. It has been 5 weeks since this and the area around my mouth is still raw. How damaging are the effects of smoking on a jaw implant and how long would you recommend abstaining from smoking?

    Reply
    • Hi Jim,

      Smoking impairs the healing of bone. If you smoke more than 10 cigarettes a day, you can have problems with advanced bone grafting. For a block graft, you should abstain for 1 month after surgery and 1 week before surgery.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  376. Hi, I had my back right molar extracted and grafted a few months ago and then the
    Tooth in front of that the same surgery 6 days ago. Iam having a tremendous amount of pain this time, is this normal? It is a deep seated aching pain, Iam taking Pcn vk for an abx and only have one day left. Thank you for your time.

    Julie A

    Reply
    • Hi Julie,

      I think you should call your dentist so that he or she can diagnose what is going on and actually see you. Some extractions can be very painful.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  377. Hello, I am having surgery to remove ten unexposed teeth from below the gum (lower), and these teeth are crowed beneath where numbers 22-27 would be. The surgeon will remove these teeth and fill in the void with bone graph, and I am wondering how long before I could talk comfortable to work again.

    Reply
    • Hi Anna,

      This question would best be answered by your surgeon that has examined you and seen your x-rays or CT scans.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  378. I had bone grafting done three weeks ago, today my stiches were removed and filler/splint was added to my front and two side deeth. I am not very comfortable with splint but it was nesseccary as my teeth had too much of a bone loss. Can splint be removed once teeth are strong and sterdy?

    Reply
  379. Is the extraction and bone Grady procedure something a competent dentist can do, or is it best be done by a surgeon? Any insights on it’s complexity and who should do it is much appreciated..
    Thanks
    Jimmy

    Reply
    • Hi Jimmy,

      Every dentist is different. It doesn’t matter on their specialty but rather on their training, judgment and experience.
      Spend time researching the right dentist for you and your situation but I cannot emphasize enough how wide the difference in experience can be. Some dentists do this 1000 times a year and some do it twice yearly.

      I hope this helps!

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  380. Hi LaVerne,
    It is possible though unlikely. In my Burbank dental implant practice, medical insurance rarely picks up dental implants or bone grafting.
    It is worth a try though, but don’t get your hopes up.
    Sorry!
    Ramsey A. Amin, D.D.S.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow of the American Academy of Implant Dentistry
    Burbank, California

    Reply
  381. Hi Dr. Amin,
    just 6 months ago I had jaw surgery to correct an extreme over grown lower jaw. Now I want the teeth i have lost many years ago to be replace because now that my jaw has completely changed I wonder if any of my procedure will be considered reconstructive instead of cosmetic.
    La Verne B

    Reply
  382. I have been going through dental implants and so far they have not worked. They keep having to take it out or move them. My last problwm was the implant went up into my sinus and they could not get it out. They stitched me up and said we would have to wait till it came down. 2 weeks later they opened up the gums and dug out the implant it was horrible. Have you ever heard of this happening. Portions of my gums and roof of my mouth are still numb and some parts still hurts and it has been 2 months since they dug out the implant, is the numbness and tenderness normal? Now they are going to try a block of bone to build it up and try 2 more implants and I am scared of going through more of the same. It has been 1 1/2 years since they started. What should I do

    Reply
  383. Hi. I was supposed to get the process started earlier this week. I got my wisdom teeth out and I guess there was not enough bone. It is my upper front tooth, my surgeon has not told me how long it would take. I really wanted to be done with this before college! What is a bone graft made of and what color is it because i have white stuff where the graft is. I am rinsing and it is’nt coming off.
    Should I be wearing my retainer? i think it would hurt. Thanks

    Reply
  384. will i be able to tell when the bone graph is healed? Also the gum about the bone graph is staarting to pulseate

    Reply
  385. Dr Amin, I had implants 3 months ago. Today my dentist told me I might need bone graft. Is it normal? I thought bone graft is done before implant. Does that mean the implant failed? I am very nervous. My implants are for upper #7&10. They are missing from birth. Thank you!

    Reply
  386. Hi Dr Ramsey,
    I had a bone graft about 7 weeks ago (tooth #7) and still have swelling and alot of soreness. My Dr. supsected a sinus infection because the e-ray was clean and showed no infection. But strong antibiotcs have done little to help if at all. How often does a bone graft not “take”. And when this occurs, how is it best resolved? Thank you in advance for your time.
    Phil G.

    Reply
  387. Hi Carolynn Lewis,
    Great questions! In many instances, your existing gums can be “released” in order to cover the new volume of bone.
    A gum graft is usually done for front implants, but is sometimes used in the back.
    When I have to do it, I often try to combine the gum and bone graft together.
    Does this answer your question?
    Dr. Amin

    Reply
  388. I consulted a Prosthodontist about an implant for a missing front tooth that is apart of a three crown bridge. Years ago, I had dental surgery and braces to correct an overbite. The overbite never was corrected to the level I wanted. The Prosthodontist told me he could do an implant and bring my bite in but would have to crown a perfectly good tooth in the process. Because the two teeth on my crown have root canals, he could bring them in but the forth tooth on my left (the good tooth) would stick out. He suggested crowning that tooth. Could I do braces instead of destroying a perfectly good tooth? What are my options?

    Reply
  389. Hi! I need dental implants in the lower left area to replace two molars and a bi-cuspid. My oral surgeon wants to take a block from the right side of my jaw to place in the area to make it higher and wider. He never mentioned anything about my gums. The teeth have been missing for about 20 years. My concern is that I am not going to have enough gum tissue to pull over the bone. Should I ask him about this? Also, the area where the bone is taken from, does that also take about 6-9 months or so to heal? Thank you so much.

    Reply
  390. Is it normal to lose a few granules of the graft materiel during the healing process? I had a graft on my lower jaw just under 2 weeks ago. It went well, with relatively no pain. Stitches were removed at one week and all looked well. Gums are healing nicely but occasionally during the day I will feel a piece of the graft materiel working it’s way out of the area. Is that something to be concerned about?

    Reply
    • 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

      Reply
      • Stitching the wound second time almost never helps. I would suggest you just allow it to heal. You will probably lose some bone volume but hopefully your dentist can recover that at the time the implants or place. Often times secondary bone grafting is needed especially for upper front center teeth where cosmetics is everything. You will be fine.

        Reply

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