(updated January 2024)
My patient called me to ask what is that white thing there? In other words…is it normal that my extraction bone graft membrane (white) is showing?
An extraction socket bone graft for dental implants that has a non-dissolvable membrane should look like this while it is healing. This procedure is done in preparation for dental implants.
I told him that it is a non-dissolvable PTFE (polytetrafluoroethylene) membrane with PTFE stitches. It holds the bone in and prevents gum from growing into the socket.
What to expect with a membrane bone graft
This is intended to stay like this for about 3-6 weeks. The reason why I suggest you have your socket bone graft done this way is that the results are very predictable. This white membrane with good technique has a very predictable outcome. It is all about the technique not so much the product. Experience matters. The most important thing is that your socket is completely cleaned out and that the membrane is stable.
He just really wondered what this white piece was. He came back a few weeks later and I snipped the sutures and removed the membrane in about 60 seconds. This is typically very painless.
After removal of the membrane you should see pink new gum healing with possibly some surface bone particles if a particulate graft was used.
Here is the complete photo series from failing root canal x-ray, extraction, bone graft, membrane healing at 10 days, implant placement with L PRF platelet gel, final x-ray of two dental implants:
So it is important to clarify that on this patient that I extracted two bad root canal teeth that this membrane was purposely left exposed. Some membranes that I put in are under the gum and not intended to be exposed at all. The specific type of PTFE membrane does well exposed.
If you have had this done, do not chew on this area until everything is completely healed and the bone graft membrane is out. The bone typically takes 4-6 months to form.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
I just had a full lower jaw extraction. It appears to be three separate running sutures. I am not clear on how many bone graft deposits were done, but I think he only did the right side and said I would need to come in one to two months after the top extractions to fix any further bone grafting. My LR29 (I think) was previously broken down below the gym and the scooped hole was completely open and remained open as I cleaned food out every night during brush, floss, and rinse routine. After full lower jaw extraction the suture at the LR29 site was completely closed. And now, it is slightly opened, direct center. Where, before extractions it was a scooped bowl shape under gum line, it is now a slight umbrella shape and the opening would be the umbrella tip. There is a greyish-whitish color that is exposed, (a sort of diamond shaped opening.) and texture of it feels pretty firm.
I am wondering if this is the bone grafting exposed, and if it’s okay, or should I be worried that it is food deposited within the suture opening and I should try to gently cleanse it or leave alone?
Secondary intention healing is what is happening. Secondary intention healing happens when a wound is too big or complex to close up right away. Instead of the edges being stitched together, the body heals the wound from the bottom up, filling it in with new tissue over time. This process is slower and the wound stays open longer, but it’s the body’s way of repairing larger areas. You’ll need to keep it clean and follow your doctor’s instructions for care as it heals.
So, in a nutshell, secondary intention healing is the body’s way of fixing larger or more complex wounds from the inside out, bit by bit, rather than quickly closing up the edges.
I had a bone graft done end July was originally going to have implants We figured it was too expensive My dentist put 16 stitches in I went for teeth cleaning a week ago my gum is white where the bridge was extracted and a little red I am going to see a oral surgeon Hope it’s nothing serious I am a five year breast cancer survivor
It should be ok. The mouth heals really fast.
Do these membranes and procedure normal to cause bad breath? I mean it’s terrible, I don’t wear a mask for COVID anymore but I wear it to save the people around me!
Oh gosh 🥺 it sounds like things are not healthy. It is possible that you are not forming bone properly and you may have an infection. I would suggest you see your dentist and certainly antibiotic coverage would be important. What antibiotic are you taking?
Hi Dr. Ramsey,
I’m very worried about this last procedure I had. Would I be able to send you an x-ray picture and maybe you can tell me what you think is going on? I would really appreciate it! Please let me know if it’s ok to send and where to send it to. Thank you!
To benefit others I only allow people to post to a Google drive (etc) of public link. If you can do that I be happy to take a look.
Is redness normal two weeks after alveopladty and extractions,? Still have swelling and numbness also:(
top or bottom?
Dr Ramsey,
I haven’t seen this question asked yet. I had my last lower left molar extracted about four days ago, bone graft and collagen in place. The inside of my cheek seems to be puffy and swollen and almost seems to be attaching to the gum at the extraction sight. I am considering having an oral surgeon peek at it as I am not real confident with my dentist. What are your thoughts on this one? Also i am moving soon to a different state and she was ok with removing stitches before I leave at around 2 1/2 weeks post procedure. I would love to hear your thoughts?
2-1/2 weeks is probably sufficient. It really depends on the technique and materials though. If it is just dangling and doing nothing than it should be removed. If it still feels tight and may be consider removing it when you arrive in your new state. Good luck on your new endeavors
5 days after a single tooth removal and bone graft, should my gums around that area look like the elephant man? I had ONE absess prior to the surgery, now I have several new ones. Normal or infected? Thank you!
Cannot tell without seeing you. Fortunately the mouth will heal quickly!
Dr. Ramsey,
I had bone graft last week and a couple of days ago the area has been covered with a white sticky (creamy/heavy) texture. I’m scared and my next appointment is next week. Is this normal or should I seek emergency?
Thank you
Jen –how did it go?
Hi just came across this forum because I had serious questions.
I had molar #18 extracted after a serious abscess infection underneath a precious root canal.
I lost a significant amount of bone which resulted in me getting a bone graft. The dentist I saw obviously sutured the wound only ONE DAY AGO.
The sutures have already completely torn apart, exposing the entire white membrane. My mouth is beginning to hurt again. It does not look like the white membrane is even underneath the gums, just barely laying on top of the bone particles. Would I need to go back to get this re-sutured ? I woke up yesterday with the stitches coming out and as the day progressed and I woke up this morning, they were almost completely non existent.
🥴re-suture never works. It has to be done well from day one. It will fill in over time and hopefully still develop a lot of bone 🦴
Time will tell
I just had a bone graft procedure on second lower right molar. The dentist decided not to put membrane after putting the scrapped autograft. I asked him, but the answer was “it is not necessary” and without further explanation. Is it common practice? what is the main reason for a dentist not to opt covering the bone graft site. The resorbable sutures fell out on day 5 and now the bone graft site is partially open. Is it still safe?
It should be ok 👍🏻 autograft has to be really compacted to not use a membrane. PRF made from your blood 🩸 is also a great option or just a piece of collagen could work in THIS situation
i just had #29 tooth removed yesterday but this morning i see and feel the opening like it has a smongie feeling to it does it stay or should it desolve by itself thanks so much
Spongy? Is that the word you are using? It is probably ok
Greetings, Doctor.
I recently had a bone graft completed after an extraction. My dentist used an resorbable collagen membrane as opposed to one that is removed later. I’m only two days post-op, but the area feels spongy and soft when I touch it with my tongue (which I promise I’m trying to avoid doing lol). My question is, does that seem normal for a resorbable membrane?
yes –they are not rigid
Dr. Amin, I had a socket preservation bone graft done at the time of extraction, I don’t think my dentist put a membrane on top of the bone graft because several days after the surgery I could see the white bone particles in the socket without any kind of cover/barrier. Should I get a membrane?
It’s been 3 weeks since the surgery and the socket hole is still there because gum is still not closing over the hole… This resulted in food being stuck in the hole all the time… Is this normal? When can I expect the hole to be closed? I’m worried that if food always get in the hole I may get an infection… Please help, thanks so much!
oof…it will heal but with less than ideal bone formed. 😥 But, good news is you can add more if needed at the time of implant surgery!
Mine is similar to what the other lady discribed. I had a plug like membrane for a few days, stitches came out quickly, now it looks like flesh with some white spots and little chards of bone fragments sticking out daily.
Exactly what mine looks like now, how is yours now?
Hi Dr. Amin,
I had bottom tooth that had a sever infection for a number of years eating away at the bone and had
it extracted and a bone graft done with the white membrane shows about 4 weeks ago.
Yesterday they took off the membrane and I notice the side of the gum where the infection was is
still pink and open. Also notice some white what looks like bone pushing up through gums.
They have me cleaning the area with the special mouth rinse they give you that I just blot on with a
cotton ball. He wants me back in 4 months and will do a bone scan.
Do you think this is healing properly? Is there any think I can do to help the healing along such as
calcium pills and/or eat certain veggies or fruit? I am 64 years old so I no you don’t heal as fast as someone much younger.
Regards,
Brenda Hayden
Totally fine in most cases. Vitamin D is always a good thing for bone healing!
I had my implant done about 3 months ago, now I see a little purple through the gum, if I touch it, it kinda goes away. Is that the implant and could that be normal during the healing phase? No pain or swelling!
I do not know your exact situation but it is probably okay if it was intended to be a healing abutment rather than a cover screw
Is it normal to have numbness in your lip after dental implants (3 months post implant )?
Emina —look at this post on nerve.
For some really SUPER advanced cases, it can be more common.
Do you have ANY sensation or is it FULLY numb?
I do have sensation, it’s not completely numb and it comes and goes. Also, it is normal to have pain when you touch the area- I also had a sinus lift and I can feel a little pain when I touch the area.
Pain is not normal beyond 3-6 weeks.
Sensation is great! Vitamin B complex to help with the numbness,
It’s more like a weird feeling, maybe very minimal pain- no swelling no redness. Have you had patients experience that before? I’m 3 months post implant.
Hi Dr. Amin,
Thank you for such a great blog and in-depth responses. I had tooth 19 extracted last week – fracture old root canal.. and a bone graft was put in with prf. When I look inside my mouth with a the phone flashlight I see a little pink mound at the back left side where tooth was next to tooth 18. The rest of the socket looks white either as little pieces of the graft or maybe stitches. Is that pink little mound part of membrane or supposed to be there? I obviously haven’t touched it and wasn’t sure what it was! I am not in any pain and just finished the antibiotic. It is on the back part near tongue not front of mouth. Thank you so much!
Hi Deb,
Just leave it alone and go in for your follow-up visit. Normal healing is usually a mixture of pink and white.
Hi Dr.Amin,
Thank you so much. I hope it’s ok to ask a follow up. My appointment was fine but he had also taken a biopsy of a cyst near my impacted wisdom tooth 17 . He said it’s benign- ie follicular dentigerous but still seemed to want the whole cyst removed as well as possibly the tooth 17. I am wondering as I’m in late 60s and may have had this for years if it’s necessary or what is typical timeline.. I never had a panorex or ct scan before and wonder if I need to do this now given it supposed to be slow-growing. I have no pain at all or issues. Thank you for any insight into this. I’m also reluctant to have another ct scan as I had one elsewhere a month ago but they couldn’t read it at this office and am concerned about the radiation.
Dental CT scans are very different than medical CT scans. There is much less radiation. I would suggest another one if needed.
I would remove the cyst. It will weaken your jaw which can lead to fracture of your lower jaw!
But I have not seen you or your X-ray.
God bless you for your time.. I wish I found this earlier.
Is a membrane always necessary with extraction and bone graft? I just had tooth #31 extracted because it cracked just above the gum line. I am planning to have an implant so a bone graft was done , an intrasocket dressing was placed, but no membrane. Is this ok?
Is a membrane always required when having an extraction and bone graft? I just had tooth #31 extracted because it broke off just above the gum line and am planning to have an implant. It was an easy extraction and the surgeon did a bone graft and placed an intrasocket dressing but no membrane. Is this ok?
Not always required but usually better to have one. #31 is a unique tooth. Read about it on this post about last molars.
😁
I got my bone graft and membrane application about a week and a half ago on my inferior 3rd molar. I dont know if the membrane is supposed to be reabsorbed or if it will be removed but i can only see a tiny piece and the gums are on top of it. Also im still having some discomfort and when food gets there it makes me feel like i have pressure so i have to be constantly cleaning after eating.
Why was a bone graft done for a wisdom tooth?
What if the membrane moves out of place and is no longer covering the bone graft particles? I just had a socket bone graft done and the stitches are in place but the membrane moved to one side leaving the graft exposed. I appreciate the detail on your website!
It will still heal. But when the membrane moves out of the area it basically serves no purpose. 😞Depending on the complexity of your bone graft and number of missing bone walls it may or may not heal with full bone volume. Just get the membrane removed and let it heal for longer before you put the implant in. I will give it a minimum of four months and up to six months. You might need a secondary bone graft.
It should not be too big of a deal to correct if needed in the hands of a skilled implant dentist.
Hi,
I recently had dental implants done about 2 weeks ago and now I have a bump on my gum, it feels like some material from the bone graft, but I am not sure. I have no pain, no redness. It’s just a little uncomfortable and I can feel it with my tongue, is that normal after dental implants, does it go away on its own ?
It may be some extra bone graft material or an area where the membrane has folded. Either way it’s not going to be a big deal. It might go away on its own or it might need to be smoothed down If it does not go away in 4-6 months 😊
Thank you very much, I truly appreciate your time:)
Hi! I had a tooth extracted and a bone graft done about a month ago. My bone graft did look like the photo above but since the stitches have came out/dissolved the white area (looks like mesh) went from the size of a pencil eraser to a very large area (triple the size it originally started). I went to the doctor after it doubled and he said we would just trim the bone down and fix it when we do the second part of the implant 3 months from now. Now that it’s tripled in size I’m concerned again. He has told me to continue to use the antibiotic mouth wash twice a day until my next appt. Is the size getting larger and my gums appearing to recede more normal? It doesn’t hurt and I’m avoiding chewing on that area. I just hate to pay another follow up appt if it’s completely normal. Thanks in advance.
Hi! I got my #31 tooth extracted and got bone graft too because I want to get an implant. So the dentist put a non-resorbable membrane but it’s not fully submerged under my gums, there’s a spot where the membrane is over my gums. Is that normal? Also He’s gonna remove stitches in 2 weeks, is he gonna remove the membrane since it’s not fully tucked in, or is it supposed to stay in and remove at a later time? Thanks
Membrane is usually under the gums. Does your look like the images on this post?
On the side next to my cheek, it looks like the images; but on the other side, the dentist told me my gums were very thin so he couldn’t stitch the membrane under my gums
Hmm. There are special methods for thin gums.
I’m sure it will work out though 😁
Hi, I had #14 extracted and a bone graft placed 6 weeks ago. There was substantial bone loss, my dr. Has me scheduled to have the membrane removed this week. Would it cause problems if I left the membrane on longer, maybe another week or 2, so that the gums can develops more or is it better to have it removed now? Thank you
The membrane usually only needs to stay there for 3 to 4 weeks. Six weeks is too long. Take it out.
Thank you for your reply. I had it removed this week. They told me to start brushing on the area when I brush my teeth. Would you recommend that also? Are there any other post membrane removal advice you can give? And how long would you recommend after a bone graft to wait for an implant surgery? Thank you
I think I answered this ? If not please reply 😀
Thank you for your reply. I had the membrane removed this week. They told me to start brushing on the area when I brush my teeth, would you also recommend that? And are there any other post membrane removal things I should be doing? How long would you recommend waiting for the bone graft to heal before having the implant surgery?
Let the bone graft heal for a minimum of four months. Even up to six months. Better for it to be more “cooked.“
You don’t need to do anything special. Maybe just avoid chewing on that side until the gums thicken up a bit. 😃
Let the bone graft heal for a minimum of four months. Even up to six months. Better for it to be more “cooked.“ You don’t need to do anything special. Maybe just avoid chewing on that side until the gums thicken up a bit. 😃
Mine is coming out after 3 weeks on its own. Is this normal or should I call the surgeon? Thx!
If it is the bright white type that is probably a good timeline to take it out.
😁
Hi Dr Amin
I just had a bone graft two days ago. The doctor said he put a membrane and stitches but when I look at the site I don’t see any membrane just stitches?! I’m so confused if the membrane fell out or not. Could it fall out without me noticing or pain?
I still see the stitches and the stitches area looks dark red/black. Is that normal?
The membrane for the bone graft was under the gums. That is most likely the situation.
Hi Dr Amin
I just had a bone graft two days ago. The doctor said he put a membrane and stitches but when I look at the site I don’t see any membrane just stitches?! I’m so confused if the membrane fell out or not. Could it fall out without me noticing or pain?
I still see the stitches and the stitches area looks dark red/black. Is that normal?
Hi! I recently had bone graft about a week ago and I also need some orthodontic treatment. What I want to know is can I not choose to have implants and can the teeth be just moved? I’ve had a talk with my dentist that I want to just move the teeth after extraction but she said I had to see a tmj specialist that would delay my ortho so the bone graft had to be done bc she said I don’t have enough bone on that upper right molar
It depends…it is hard to bodily move a tooth a long distance. (What I want to know is can I not choose to have implants and can the teeth be just moved?)
Hi Dr. Amin,
Firstly, thank you for providing this service! One week ago I had a lower left molar extraction with bone graft.
My questions are:
1. Is the mesh like substance with holes the actual membrane? What is the gel substance?
2. Is it normal one week into this process that the gel like substance fell off? (stitches are still in place)
3. I specifically asked my dentist if I need antibiotics and he said ‘no’. I am 56 years old and I do not want complications of infection.
Note: Other than needing Motrin at night and in the AM I am relatively fine. BTW: I am a huge baby, so I know I am probably over reacting – but I wanted antibiotics as extra insurance more than needed them. Better safe blah blah blah….
Thoughts?
I appreciate all time! – Paula
It should look like this. And antibiotics and useful when bone that is not your was used! The gel may have been L-PRF made from blood from your arm?
Thank you! As you say it took time – and now everything is well. ~Paula
Is it normal for the white bone graft to show more and more on the side of the gums (close to my tongue). My tongue runs against it constantly so it is irritating however just want to make sure the gums will heal and cover the graft back up or is something wrong.
I had a socket graft done March 9, tooth #11, the gum tissue is still red/irritated. I saw my dentist last week because I was concerned. He said its red due to the extra bone particles. Does gum tissue usually stay red/ irritated after a socket graft?
sometimes…but only at the surface…not deep in the bone
Hi I had a implant done on my upper left front tooth about 2 years ago now and it has like a white kinda some black stuff around it behind my tooth toward the top idk if it’s something to be worried about or if it’s normal it doesn’t hurt or anything
You need to see someone asap. The implant maybe losing bone.
Twenty-three days ago I had a lower right molar removed and a bone graft placed. The surgeon extracted blood for a “plasma rich fibrin membrane” and likely some other type of membrane covering. I recovered from the surgery pretty well, took all my amoxicillin at the precise times, followed all the advice re: oral hygiene, and eating. I was told not to chew on the right side of my mouth for a month and was scheduled for a follow up Jan 9 ( a little longer than a month post surgery and bone graft). The stitches dissolved at about day 7 or 8. THe area feels really good, but instead of gum tissue growing closer together, it seems to have widened a bit and I can see a bit of the membrane, but the gum edges are “rolled” over the site still. I just assumed that the gum edges would grow closer together and I am freaking myself out about the edges getting further apart. It was just a slight gap and now it’s a bit larger—seems like it is going in the wrong direction. THere’s no redness, no blood, no pain. I even forget sometimes that something was done.
I rinsed with the peroxyl for more than 7 days and wonder if I slowed down the healing. Now I just rinse with the warm salt water after meals.j Then I wondered if the gum was even SUPPOSED to heal over the membrane (have no idea if it is re-absorb type or not). I haven’t accidentally brushed the surgery area and use a q-tip to clean the molar behind and the tooth in front. I avoid using the waterpik on that side of my mouth.
Eventually the plan is to get an implant. It was super expensive and I’m a bit freaked out, but wondering if I am over thinking it.
We all have the tendency to worry. It sounds like it is going well. The gum will close for sure. It may be purposeful in this scenario.
Is it normal after a week of having a tooth extracted and the white membrane being placed, that your breath still stinks?
You need to clean around the area. Go ahead and brush gently or use a Q-tip with some Listerine or special mouth rinse that was provided by your dentist. Nothing should be stinky..
15 days after bone graft and a sliver of white membrane is gone (possibly from accidentally chewing on that side for a second) The majority is intact. Seeing doctor in a day for scheduled check. Will bone graft be ok?
Call them tomorrow. It may have been a “membrane.”
>If you have had this done, do not chew on this area until everything is completely healed and the membrane is out. The bone typically takes 4-6 months to form.
Thanks for your reply! I am now 8 days post op and in a lot of pain. The hematoma is slightly better but pressing on the surgical site. In addition, I feel a throbbing pain in the area where the gums where sutured and I am leaking a few “bone grains.” I also have a foul taste in my mouth for this last 5 days. I saw my oral surgeon 4 days ago and will see him again tomorrow. I told him I was worried I had an infection. He said it’s too soon and I’m on Amioxicillin. Have you seen patients with infections sooner than 2 weeks while on antibiotics? Thanks!
I am sorry this comment got missed. How did it all work out? Dr. Amin
A week ago, I had a bone graft done in my upper right jaw because I have 2 missing teeth there. I am on Brillanta, an anti-platelet medicine. The surgergical site kept oozing. So, about 4 days ago, my cardiologist allowed me to stop this medicine and use low dose aspirin instead. This helped the bleeding, but I developed a hematoma on my cheek! My surgeon just said to put warm compresses. My daughter is s nurse and says they can use ultrasound to break up the clot. Have you ever had this happen? What is your advice?
Heat, pressure and time is best. If you have access to the ultrasound you can try that but it is not common in dentistry.
I have just had #14 and 13 extracted and bone graft. I was told to wear the Essix retainer 24/7 only take it out to rinse. I have read not to wear the Essix at night when sleeping. What would you recommendation be?
Not to wear the Essix at night when sleeping is best
I had a bone graft on my lower jaw two months ago. It appeared to be healing with, but now a white spongy material is showing. It is not red, swollen or painful. I am worried the graft is failing.
Have you seen your dentist to check it? It is probably still ok!