Bone Graft Membrane Sticking Out And Exposed

(updated January 2024)

(Another great post on membranes.-Click here to see what they look like in the the mouth)

These are questions and comments I receive constantly on my blog and from patients who come to see me in Burbank, California.

New patients who come see me ask, “Is it okay if my bone graft membrane is sticking out and exposed?” Or they say, “My bone graft is exposed above the gum. Is that okay?”

Join me to uncover the answer!

socket membrane

Ramsey Amin DDS

membrane space

Do I need a membrane for my dental implant bone graft? What is the purpose of the membrane for bone grafts?

A membrane is a barrier. Its purpose is to prevent gum from growing into the bone cavity.  On many bone grafts for dental implants, a membrane is placed over the bone but under the gum. 

There are many different types and styles of membranes, but they break down into basically 2 categories:

  1. Dissolvable (resorbable) membranesCytoplast implant membrane
  2. Non-dissolvable (non-resorbable) membranes

Both resorbable and non-resorbable membranes have their use. 

A resorbable membrane will dissolve on its own. Non-resorbable membranes typically need to be removed at some stage during your bone graft/dental implant procedure.
collagen membrane

Resorbable membranes:

Most resorbable membranes used, as of 2019, are made of collagen.  Collagen is a protein which you may have heard of in products such as shampoos and conditioners.  It is heavily cross-linked and makes an excellent barrier.  Most commercially available collagen membranes are 15 x 20mm in dimension and look like a flat, white piece of cardboard.

They are trimmed with surgical scissors by a dental implant specialist and typically covered over bone.  Most collagen membranes are made from bovine Achilles tendon or porcine origin, which basically translates into cow and pig.  Some resorbable membranes dissolve very quickly in just days; these are typically called plugs, while other resorbable membranes can last approximately 4 months.  Most resorbable membranes are not tacked in place with titanium fixation tacks.  Some are even pericardium from heart tissue!

The other types of natural resorbable membrane would be one made from your own blood!  Platelet rich fibrin or also known as PRF, can be used to make membranes from your own platelets.  Basically 1-6 test tubes of blood is drawn at the time that I start your IV.  Those test tubes are spun in a machine called a centrifuge, which separates out the layers of your blood.  It also concentrates your blood to be used for other platelet rich preparations called PRP and PDGF.

PRF can be used as a resorbable membrane as it tends to last 7-14 days.  It is stretched out and made thin so that it can be sutured.  It becomes a durable, kind of slimy consistency which can protect a bone graft.  PRF membranes can be used in addition to resorbable or non-dissolvable membranes for dental implant bone grafting.  PRP/PRF can speed up your healing and reduce pain and complications.

There are also synthetic membranes that dissolve, such as Vicryl, which are not as commonly used.

Non-resorbable membranes:

Most non-resorbable membranes can be made of titanium and dPTFE (Dense polytetrafluoroethylene).  They are materials that form a barrier that cannot be dissolved by your saliva.  Some non-resorbable membranes, such as PTFE, are often combined with bone tacks in order to hold the membrane stable and cover the grafted bone.

One benefit of a non-dissolvable membrane– they are very predictable in generating bone.  The main downside– it has to be removed at a second procedure.  Sometimes that second procedure may involve just plucking out the membrane off the top of your socket graft or it may be more involved, such as completely reopening the gum, removing the bone tacks, and then removing the membrane.  Typically when membrane removal involves removing tacks, the dental implants are placed at the same time that the membrane is removed.

PTFE has been used for over 30 years in cardiovascular applications such as suture, vascular grafts, and heart valves. PTFE is bioinert and does not cause inflammation.

Titanium reinforced membranes, or titanium mesh, is best at holding a space.  It works like a tent and prevents collapsing of your gums to build new volume and mass underneath.

Sometimes the membrane on a socket graft will be removed after 3-6 weeks or may even fall out if it is a dPTFE style membrane.  This is okay, generally.  The purpose was to allow your gum to grow underneath it and cover over the bone graft as the membrane protects it.  Once the membrane falls out or is removed from a socket bone graft, the bone still needs to heal for usually another 4-6 months before dental implant placement.

Is It Okay That My Bone Graft Membrane is Exposed (Showing)??

It depends!!  If the intention of your membrane was to be exposed from the beginning, then it is okay that it is exposed right now.  If it was the intention for your gum to remain covering over the membrane for 4 -9 months, then you are likely having a minor complication called a dehiscence where the gum becomes exposed and naturally exposes the membrane and bone graft. 

A bone graft membrane sticking out and exposed is not always a problem.

The more critical the bone graft is, the more critical it is that the tissue remained closed and the membrane is not exposed at any time.  Critical bone grafts would be onlay block bone graft, lateral window sinus bone grafts, nerve repositioning, and advanced guided bone regeneration (GBR).

A standard socket bone graft (where an outer wall is not missing) would not be considered a critical bone graft; so leaving a membrane exposed is okay.  If an outer wall is missing, this would be considered a critical size defect.

It is important to maintain proper follow-up with your dentist throughout the procedure.  It is likely that you will be on an antibiotic, such as amoxicillin or clindamycin, and a mouth rinse called chlorhexidine gluconate.

Keep in mind there are literally hundreds, even thousands of different membrane manufacturers each claiming to be better than one another.  Yes, there are better manufacturers than others, but ultimately the surgical technique, training, judgment, and expertise of your dental implant specialist is going to be the most critical factor in the success of your bone graft…choose wisely!!!!!!

You can use all of the best materials in the world, including growth factors such as  PRP/PRF/PDGF/BMP, but in the hands of an inexperienced surgeon, results may not be that good.  Of course your ability to heal is of paramount importance.  Smoking never helps.  Alcohol does not help either… Both of these slow down the healing of bone and greatly increase your chance of complications.

Wearing a removable, temporary “flipper” over a bone graft is to be done with extreme caution.  Pressure from a removable temporary will cause the bone graft and membrane to move and almost always results in failure.  Be sure you and your dentist speak about the use of a temporary and how to create space underneath it so there is no chance that it can apply pressure to the bone graft.  Some bone graft membrane reconstructions are so critical and so large that the temporary cannot be worn at all, but that is the exception rather than the rule.

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

Burbank, California

217 thoughts on “Bone Graft Membrane Sticking Out And Exposed”

  1. FYI _ I left an earlier comment on five times being sutured on lower front gums after surgery on older root canal infection. The endodonist restitched the suture and he said he had to go into the lower lip somewhat to stabilize the suture since there wasn’t enough material on the gum. He placed what I think is dental gum over the whole area of the incision and will pull if off in seven days. He said the gums need to heal, and only liquid diet and little movement of lower lip needs to happen. If not successful this time with need to see a periodontist. Any feedback would be appreciated.

    Reply
  2. Hello Doctor and thank you for this article.

    My question is, is the plug supposed to be visible? In my case I extracted tooth 31 with 30 already missing and 32 still in place. My dentist placed bone graft material, a plug and put stitches. The plug expanded in a few hours making its way out of the gum and breaking the stitches. It happened 2 times. After the second time I went to a different doctor. He repeated the procedure and it looked very nice at first but now, 5 hours later, the plug seems to get bigger again even though stitches are still in place. Even if stitches remain in place, will gum find its way to heal. Cause this plug looks like an obstacle. Why is it happening?

    Reply
  3. Hi! I had a bone graft done about a week ago and now have a piece of bone graft stabbing me from the inside my gum. Will it dissolve or do I need to get my dentist to fix it before it becomes solid bone poking into my gums?

    Reply
  4. Hello Dr, I have a quick question, hoping that you are still active on this article! I got an upper molar removed last week, and a bone graft procedure done, with a membrane that needs to be removed in a few weeks. However, recently (2-3 days), I’ve been feeling some bone graft particles, probably around a dozen or more a day. As far as I can tell, the membrane is still there. My dentist said over the phone that some bone graft particle loss was “acceptable”, but I am not sure, this seems like a lot.

    Reply
      • Hello! I had my tooth extracted six days ago and had the bone graft with a dissolvable membrane. The membrane started sticking out on day two and now it is completely exposed. I have a bad rate in my mouth coming from that area. Is it possible that the membrane is decaying or going bad since it has not dissolved yet? Would it need to be removed? I’m worried that it may not allow proper healing of my gum since it seems to be covering that area. I have done salt rinses etc to keep the area as clean as possible. Thank you!

        Reply
  5. I had #6 and #11 extracted on 2/8 because my ortho could not bring them out of the palette. I had bone grafts (socket) with collagen membrane to prepare for future implants. One of the membranes came out on 2/11 and upon closer inspection, I see an empty hole. Does that mean the graft failed? Only a few flakes have come out here and there, and I do not have any pain.

    Reply
  6. Dear Dr. Amin,
    I had my tooth removed and bone grafting placed. There is membrane to be removed in a month. Is it common that my palate is raised because of the membrane? and is it correct that once the membrane is removed, the raised part will go back to flat? I first thought half of my palate (the wall of my inner mouth, upper part surrounded by teeth) was swollen. It still feels and looks like swollen. and, because of this, I can not say some words correctly. (because the raised part / or swollen part prevents my tongue to move freely. ) Is it swollen or is it raised, do I need to be concerned, or not worry? I had an uppler back tooth removed, and that part of the palate is raised / swollen.

    Reply
  7. Hi Dr. Ramsey,

    Thanks for the post. I’ve been in a massive fix now.

    My front tooth was extracted a few years back and since an immediate implant wasn’t placed, I had to go in for a bone grafting surgery. The surgery was fairly painful, took over 3 hours. My mouth was bleeding for 3-4 days post the surgery. This was a synthetic graft. I was told the surgery will be painless, but it was bleeding and extremely horrible.

    Now it has been about 1 month since the surgery, and I visited my dentist and they saw that the membrane was exposed and that they will need to go a gum graft to be able to cover it.

    It seems fairly odd for a gum graft to be needed for an exposed membrane. My gum looks terrible and I am extremely scared of these dentists now.

    what should I do?

    Reply
  8. Hi Dr.,
    I had an extraction done almost two weeks ago with a bone graft and I believe a non-resorbable membrane. My stitches have all fallen out (dentist said they would) and it seemed like my gums were growing closer and closer together but all of the sudden it appears that one side of the gums are “drooping” down and the membrane has become more exposed. Is this normal? It’s also a tiny bit painful where the gums have drooped down. Also, I’ve had terrible breath in the last week or so. Could it be something wrong with the membrane? I was thinking it was from the chlorhexidine rinse completely drying out my mouth but now I’m not sure.

    Thank you!

    Reply
  9. Hi. Six days ago I had removal of a previous post/core on #9 due to bone loss. I also had bone graft (I think it is allo graft – not cadaver or my bone) at the time; unsure if membrane is resorpable though. Initially, we used the previous crown as a temporary but it fell out within hours of the proceedure. The next day, they made a temporary that lasted 4 days and then fell out – on saturday am. Originally I was supposed to have an Essix made. I am seeing my regular dentist hopefully tomorrow which is Monday. Is it too late to do an Essix? I understand the flippers can cause failure and I do not want that. What type of temporary tooth would you recommend and who should do it? Regular dentist may not want to touch another md’s surgical site but he would have made the Essix if we had done it prior to the proceedure correct? I just can’t be toothless in the front especially but I want good healing. I do not smoke or drink. Also surgeon had me text her a picture of the site when the temp fell out Saturday and she it looks really good and there is nothing to worry about. Thank you for allowing me to ask questions.

    Reply
    • Is it too late to do an Essix? NO!

      In fact if you have it made now it will fit even better than if it was made before the procedure. I am sorry that your temporary tooth came out. That is very odd. Your regular dentist should make it if they are familiar with making these types of provisionals. The person who made the implant should be in charge of your temporary because if the temporary touches the guns it can cause complications such as implant failure or bone graft failure.

      Reply
  10. Hello!
    I had a bone graft done on a molar back in February (in preparation of an implant) The doctor is removing the membrane on Friday and I am very nervous. Will the removal hurt? What will the site look like after the membrane is taken out? I have had a lot of dental work over the last few months and I don’t think I can take any more pain in my mouth. Help please

    Reply
  11. Hello, wonderful blog thank you.
    I had a sinus uplift and bone augmentation graft 5 days ago on #14 (which was extracted a few yrs ago). I had to bump up my one week follow-up appt to today, and the periodontist said something to the effect that the graft had come undone, the screw was exposed, and the membrane missing. (I have not had these procedures done before and this periodontist is not very communicative–today was the first I heard about a membrane.) I asked where the membrane had gone and he said it had gotten exposed somehow and my saliva would have disintegrated it (thanks to your blog now I know this is a resorbable membrane). I know from an x-ray there were a screw and two tacks originally placed w/ the graft, and non-dissolvant stitches. The periodontist said all this was concerning, and he pressed/moved some things around w/ a tool (gums?) and then added additional stitches he said to try and hold it up as best he could.
    I have a follow-up in a week, and am on amoxicillin and a rinse. The periodontist didn’t say exactly what could have caused all this to come apart so quickly, and I’m concerned how it happened. I’ve been following the aftercare recommendations closely. Despite icing, my cheek has been quite swollen on that side (bone was also taken from the lower jaw on that side to mix w/ cow & cadaver) and I haven’t been able to see the surgical area since the procedure, so I haven’t had a visual concept of what the site has looked like to know that things were falling apart, and I’d been trying not to roam over there with my tongue to “feel” things out. My mouth had certainly been painful and sore up through today, but I assume that’s par for course and have been alternating ibuprofen and tylenol. The perio said he didn’t notice infection today.

    1) I’d be interested in any response you might have to the above scenario, and if you think it’s best to stick w/ the same periodontist if this procedure fails, and 2) suggestions as to what the layperson can look for when trying to find a skilled dentist/periodontist! (good things and/or red flags)

    Reply
    • Probably best to stick with this person for a while just to manage the initial complications. Losing the membrane will certainly result in a compromised bone graft. It can be improved by a secondary bone graft usually but that’s going to really depend on the skill and experience of the implant specialist.

      Over the years I have seen a tremendous variety of skill level even between the very few board certified dental implant specialists. Bone grafting is extremely technique sensitive. It’s much more important that the provider have experience than the actual type of bone graft itself.

      Complications can and do occur. See how things are handled and then take it from there

      Feel free to reach out again.

      I’m assuming you don’t smoke and do not have diabetes.

      Reply
      • Thanks for your reply!

        Update: I went in this week and had stitches removed. I asked the periodontist his hypotheses on how things came apart–he said he thinks he asked too much of the gum by stretching it as far as he did. He said he’s not sure how he’ll approach the second attempt (it will have to be redone). He mentioned a technique he referred to as “sausage stuffing” a membrane, which can get “overstuffed” with bone, and said there are many membranes to choose from. I’m not sure what to think…

        Reply
      • Hi, I had bone graft on my bottom arch both sides done in Mexico three weeks ago, my left side is showing white and I am not sure what it is, I been on amoxicillin twice and now about to start Clinda myosin not sure how to spell that lol l, is there a way to send you a pic so you can take a look at what I’m seeing , thank you 😊

        Reply
        • You can post something on Google drive as a public link.

          Be be sure to mention the problem again as the picture might get lost in the post

          The bone graft may not be working and might fail. 😕

          Reply
          • The hard thing is my surgeon has not seen me since he did the surgery, this has been all over the phone and pictures , I went to my local dentist who said she does not see an infection but my surgeon really wanted me to take the antibiotics, so I’m not sure what’s going on, I can see the membrane clearly , I am in no pain and there’s no bleeding or swelling, what are your suggestions? Could he have put me on the antibiotics just in case there was an infection arising ? That’s what it sounded like to me to why he put me on the antibiotics

          • You just need to see the actual DDS who treated you. I am not a fan of the traveling dental implant dentist for this very reason. So sorry.
            This will get better!

  12. I messaged 3 years ago needing advice. I had 3 implants with a sinus lift. I became infected and was infected in horrible pain with puss draining for 6 weeks. Dr refused to go back in and I was given 6 different antibiotics. I even had videos of the copious amounts of draining to show him.
    After 6 weeks and me constantly calling and coming in crying in agony he went back in took out the membrane. As soon as he cut I felt and tasted the horrible infection drain down my throat.
    I felt better that week. Since then I’ve never felt right with that sinus. From my eye to that sinus my skin is numb. It feels weird where the sinus is. It’s still tender. If I’m stuffy I can push in it and get secretions out easily. My sense of smell is also almost non existent. I thought time would heal it but it’s still the same. The implants feel fine. No issues with them. Is this something I should seek another opinion on? Will the numbness ever go away?
    Like I said I was infected and sick for 6 weeks prior to him opening it back up. His reasoning was he’s never had one fail in 30 years. So he wanted to keep treating with antibiotics.

    Reply
    • Anyone that does any volume of dental implants will have failures. Impossible to not have any failures in 30 years unless you do not do very many cases. A very good dental implant specialist will have about a 95% success.

      https://burbankdentalimplants.com/service/failed-dental-implants/

      About 30% of what I do now is treat very severe failing implants and cases that are very complicated

      As for the numbness you are experiencing it’s not likely to ever return. If it has not returned in the first 3 to 6 months it’s not likely to come back. 😪

      If you truly lost your sense of smell you should see a neurologist. There could be a very small chance that you have some sort of a tumor that is non-related to the dental sinus work. This can give you altered smell sensation. I’m not trying to scare you but rather make you aware of other things that sometimes happen coincidentally

      Was it just a few implants on one side or was it a full arch replacement?

      Reply
  13. Hi Dr! Thanks for your feedback, I decided to go with the dental implant surgery. I am told that I can’t blow my nose after the surgery because it might tear the membrane and dislodge the implant. Is it really dangerous to accidentally blow your nose after surgery?

    Reply
  14. I had a bone graft installed where a wisdom tooth was pulled.! So, The story goes like this.!
    I had a Wisdom fully threw, or at least for the most part non the less.
    But, It was Extremely Close to jaw and muscle tissue often causing jaw pain and popping when eating.!
    Especially when it decided it wasn’t done growing.
    I accidentally chipped the tooth while flossing.
    I never had any pain or discomfort with tooth.
    I simply just wanting it filled and move on.!
    But, Dentist was persistent the tooth needed to be removed.!!
    Saying it was infected/Cavity.!! X-ray pic showed a chipped tooth didn’t look any different then rest as of color or anything in X-ray to me but, hell 🤷🏻‍♂️I’m not a dentist.! I’ve never had a cavity in my life.! Frankly didn’t want a Hole in my mouth.!
    I decided to do a bone graft.
    He used some kind of glue instead of stitches.
    I’ve done everything recommended on the process sheet I was given.
    It just doesn’t seem to be very secure.
    It feels like the bone fragments or whatever the compound rising to the surface of glue and gum. Not sure if this is normal or if I need to find a new family dentistry.!! I always thought bone grafts are put in the bone and secured???
    Advice please ?!? ???

    Reply
  15. Hi! How long does it take for gums to grow under membrane… I got a bone graft and a non resorbable membrane on top, but after a week the membrane dislodged. I’m getting my stitches removed in a week and I’m afraid the membrane will fall out anytime soon after that… is that ok? will I have a hole underneath or there’s supposed to be new tissue covering the graft already?

    Reply
    • If it has been 3-4 weeks there should be new gum there. If the membrane is dislodged, it will still heal but probably with some bone loss. This will depend on the technique and materials used. Let me know the the result! There should NOT be a hole!

      Reply
      • Hi! So I got stitches removed after 2 weeks and he cropped a little bit of the membrane since it was dislodged and it was bothering my tongue. But now there’s still some bone exposure I can see… and he wants the opinion of an oral surgeon…. Half of the membrane is still tucked in under my gums, there’s new tissue growing but there’s still a small hole under the membrane

        Reply
          • Never ever in my life smoked… and he’s referring me to the surgeon cuz behind the extracted molar there’s a lot of gum tissue that needs to be removed, but in the referral he also mentioned the exposed bone. Anyways I checked in the mirror and it seems like some gum tissue started covering my bone and the exposure looks smaller, so we’ll see… I have an appointment with my dentist next week and right after with the surgeon

      • Hi there. I had a tooth pulled and bone graft 2 days ago and the membranes is hanging out past the stitches. Is this normal? Of course my dentist is closed today

        Reply
  16. I have had two implants removed two days ago, both on my lower jaw one on each side. . today I believe the membrane on one side has fallen off completely. I’ve had bits of bone graft come out as well. I know I had stitches done but can’t tell if they have come off. Is it normal for the membrane to come off after two days? Should I worry about infection?

    Reply
  17. Hi Dr. Amin,

    I am so impressed with your blog and your detailed answers and I am hoping that you can help me. I had tooth 18 extracted two weeks ago exactly with a cadaver bone graft and nonresorbable membrane placed. The tooth extraction was due to continued pain and signs of infection after a root canal about 10 years ago. My oral surgeon said that there were no signs of infection and the tooth was removed in one piece. However, even 14 days later, I am still in quite a lot of pain unless I take 800 mg of ibuprofen. I have had to take at least 1600 mg per day for the past two weeks to control the pain. I had my sutures removed at day 7 and my doctor said everything looked great. Is it normal to require this much pain medication at this stage? I am very surprised by how painful this is.

    Reply
  18. Hi!

    On Monday, I received a tooth extraction on molar 3 with a bone graft. Everything was done pretty unprofessionally as I was not aware I was getting a bone graft until she had me sign the authorization. Bone graft is because eventually, I will need an implant there. I have dissolvable sutures in place. Today, Friday, four days after the procedure, I can outline something sort of just hanging down with my tongue. (Ive received notification that I may notice stitching coming off within a week or two, and that it was normal). I did have some stitches that landed on my mouth yesterday, Thursday. This thing that has been hanging off today, though, I initially thought it was just more sutures. I looked in the mirror and notice the gum area exposed and that the thing hanging down was white/clear-ish. I think it’s the membrane. Is it okay or normal for the membrane to be removed from the graft area? I didn’t receive word of this when discharged and had to implore most of the teaching. There was a leaflet included that explained some things, like diet, etc, but didn’t specify how long to restrict certain diets, etc, and this membrane was definitely not mentioned at all!

    Reply
    • It is not normal for the membrane to come out so quickly. It sounds like there is some communication issues. Some dentist communicate much better than others. Stay on a very soft diet and stay off of that side. I would suggest you go and see them for follow-up right away. Some membranes are dissolvable and some are not. They may need to place you on an antibiotic if too much bone is exposed. Sorry for your issues ;-(

      Reply
  19. #30 Bone graft two weeks ago and I plan on calling about this first thing Monday but always look for good advice. The membrane at first was rolling up on the inside and now feels like its lifting on that side. Should I be worries about this? My other worry is that I quit smoking and heavy drinking but have started having a couple drinks again at dinner, is this too much?

    Reply
  20. Hello,

    I had an extraction on number 19 and I asked for a bone graft since I planned to do an implant in the future. 8 months later and now 18 had to get extracted because it got an infection and a root canal would not save it. This time the dentist (same facility but different dentist working on me) added guided tissue regen resorb because he says it’s important. My first extraction did not get the guided tissue, does that mean it was done wrong and something wrong is going to happen? Now since I have missing bottom molars, how long will it take the top teeth to come down (super erupt)? Also, I’m not sure on how long it will take for me to afford getting two implants, was it a waste to get a bone graft now? Will the bone graft vanish if I don’t implant it soon? Let’s sag I wait another 2-3 years to save up. Thank you for your help.

    Reply
    • NO just different wording –My first extraction did not get the guided tissue, does that mean it was done wrong and something wrong is going to happen?

      Variable (1-5 years) ——– Now since I have missing bottom molars, how long will it take the top teeth to come down (super erupt)?

      It will shrink up if you don’t use it but should hold for 2-4 years hopefully! ————-was it a waste to get a bone graft now?

      Reply
  21. Hello,
    I had molar 3 removed on Wednesday, a mini dental implant placed, a bone graft done, and a membrane placed but not stitched in. I was told the socket has a “small fracture” after the extraction, but he wasn’t concerned about it. I am in excruciating pain – taking Aleve during the day and Norcol at night. Neither is really doing anything to help. I was on cyclomycin, but was switched to A Z pac when I told my dentist it was still hurting and swollen. It is throbbing pretty much all the time – ice helps a little. Do you think this is normal?

    Reply
  22. Hello, I had to have bone grafting done for 2 dental implants placed on my lower left side molars about a year ago and that all turned out perfectly with no complications. However, I had to have additional bone grafting done for another implant placed on my lower right side and this one is not taking like the first. My surgeon used a nonresorbable membraine on the bone graft with tacks and all, and closed the gum overtop of it. But my gums had dissonance and after about a month slowly started opening it back up and exposing the membraine. It has now been 6 months since the bone grafting was done and I should be having the implant placed very soon (with covid the offices are closed right now). My membraine is showing over the whole area at this point and it’s even making my breath smell bad. I have gone for an emergency check up on it because I was so worried and my dentist doesn’t seem concerned that so much is showing, he just tells me to keep it clean but it now smells. I don’t have any pain but I’m worried that something is going on in my jaw bc of it being open for so long. Any advise?

    Reply
    • Ugh…fingers crossed 🤞 that it has not failed. The membrane should be removed ASAP. If it smells bad there is a problem.

      Reply
  23. I have a sinus lift bone graft that was done after my upper back tooth was extracted. I can feel the bone graft sticking out of my gums and scratches my mouth on occasion, is this critical, do i need to have this corrected? is this normal?

    Reply
  24. Hi,

    I had a dental implant 2 months ago and a follow up a couple of weeks after the procedure where the dentist said everything looks good. Some stitches have been coming off since and earlier this morning, almost 2 months after the procedure, I noticed that the membrane (?) along with the threading on top of it is starting to peel off. Is this a big issue that warrants an immediate visit to the dentist? There is no pain or swelling just yet. Please advise

    Reply
    • 2 months! The membrane should already have been removed about 1 month ago on 99% of cases. Hopefully it is one that is supposed to be removed.

      Reply
  25. Hello – I had an extraction and bone graft on my tooth at 11am today, and now at 8:40 pm, I have a long white thing hanging down from the area. It feels like gum. I plan to call in the morning but I’m so worried I’ll need to go through that process all over again! Is this my membrane already falling out hours later?

    I will say my dentist told me to keep the flipper in all night as the pressure would stop the bleeding. However, I had no bleeding and the flipper was so painful in my mouth, it was such a relief to remove it. But hours after I’m dealing with this!

    Reply
    • Do what ended up happening. I am sorry I was not able to reply on the same day of your question but this is about 5 days later. Was at the membrane?

      Reply
      • I have an appointment tomorrow and I don’t think it will be good news. The white part fell out and the stitches are now out as well. Nothing grainy has come out like some describe when losing graft material. No pain or bleeding….and almost feels healed?
        I have called twice and they dont seem alarmed, so we will see! My dentist was supposed to take the stitches out tomorrow and they are gone…..so I’m not sure what will happen. I was concerned to see in the comments you said a flipper is risky post bone graft, because my dentist said it will “act as a bandaid” ….yikes….well that didnt work.

        Thank you for your reply.

        Reply
      • 4 days after extraction 2 th and putting implant membrane showing out.Visit dentist..but only nurse showed up and like” tacked in membrane?????
        Taking Amoxicilin ( have only for tomorrow).Should I bother them again?

        Reply
  26. I had a lower back molar #31 removed, Coll/App Autologous Blood bone graft & endosteal implant 12/10/19. It was placed at a slight angle, which at 1/22/20 xray showed had moved more sideways to approx 43°. My dentist said he could add an abutment. I told my dentist I wanted it removed. He demured. Phone consultations w 3 prior (cities)dentists, who told me the angle of force would be incorrect, putting even more pressure on my receding bone & high osteoporosis. I called & made appt for the implant removal & 2cd bone graft.
    At 2/27/20 appt, there showed infection & blood surrounding implant, as if my body was protecting me from it. I have always felt uncoftortable even touching any kind of metal & know I’m allergic to some (nickel etc) & had told DDS that, but he’d said 112/10/19 it was anti-allergenic. I later found out from other DDS”s that allergies to titanium & the other filler metals used in implants are rare yet do uccur in some people, especially for those titanium allergy.
    On 2/27/20 (dispite a morning quart of vegetable smoothie), my veins submerged, so I was told I would have to get a membrane w the bone graft. They used ozone water to rinse area 2xs, after infection cleaned out. I was done at DDS by 400pm & got drugs. Followed post-op proceedures. By 6pm my jaw & under side of throat were extremely swollen well past regular ‘chipmunk’ post op size (~3-4x), the pain was tremendous & it was very hurtful to swallow, could not sleep despite 2 Tylenol. In morn I went back to DDS (seen by his partner) & was told was having a rare abnormal reaction. Dr said swelling would continue 2-4 weeks, then that swollen tissue would become to hard scar tissue. Said may have to put seive in to drain fluid for 1-2 days. Told to call him if got worse. Was given Amoxicyllan percription & told to get Aleve (NSAID pain reliever). Was told if started to impinge on breathing to go to ER right away.
    Taking Amox & Aleve since 12pm 2/28, yet swelling continuing to grow & now not only side jaw & under chin, but down front & sides of throat. Air passage perfectly clear & feel zero pressure internally there.
    IMP- #1-I’m concerned am having a rare, but Severe Allergic Reaction to something (which could include possible infection). If chance of that, should have all removed- membrane & bone graft & stitches (PDE) removed.
    #2 Do I need steroids?
    Think bone (bill – D7953, DDS4 Bone repl grft ridge prsv/site) came from human cadaver material, if remember correctly, but not sure, & don’t know type membrane, sorry.
    #3-Also do not want scar tissue that has me permanently looking like 1920s circus freak (which is what it looks like now!#!)
    Please advise. Thank you ever so much!

    Reply
    • Titanium allergy is beyond rare. In 20 years of a dental implant only practiced I have never seen it and I have placed 10,000 dental implants! I do not think you need steroids at this point as it is a little bit late. Scar tissue in the gums is generally not noticeable in the back part at the mouth. I am sorry but I had a little bit of a difficult time following your story. I hope your pain has all resolved at this point.

      Reply
  27. Hello Sir, First off, Thank You for what you do here… I found your blog by virtue of the topic and because I am currently going through the same treatment; relative to implants that I will receive in near future (holes not drilled yet)… After having read through the variety of questions posted here along with your sound advice, I am compelled to inquire with you regarding my upcoming implant surgery (i.e. drilling the holes and post op).

    Long story short, I am a smoker, up to five cigarettes per day (sometimes more on the weekends). I vape intermittently throughout the day, in between cigarettes. I also drink (weekends only) sometimes to excess. My concern is that if I am unable to completely refrain from smoking, vaping and drinking leading up to (and following) surgery, the procedure will fail and/or incur significant complications (which of course I do not want).

    In my research on this topic, the resounding message is Do Not Smoke or Drink AT ALL following the procedure, less you are likely to incur Big problems.

    Regarding the need to live a healthy lifestyle during the treatment plan/surgery, post surgery, etc. can you give it to me Straight? Can I get by with harm reduction and simply lessen the amount of vaping/drinking/smoking, etc. post-surgery and still reasonably expect a good outcome? Is switching to vaping post surgery preferable if unable to quit entirely? Should an inability to quit these habits entirely preclude one from being an implant candidate?

    If a bridge is alternative option in my scenario, regardless of bridges generally being less ideal than implants, may it be me worth considering given my concern for being unable to curtail unhealthy behavior?

    Do I need to have a heart to heart with my doctor (BTW, I identified myself as a smoker/drinker on my initial paperwork/evaluation).

    Perhaps I just need someone like yourself to put the fear of God in me, or maybe you can level with me or help me prepare for conversation with my prosthodontist.

    Bottom line, my concerns here are specific to the overall concern of someone slated for implants/surgery, etc. not being able completely eliminate unhealthy behaviors that are known to cause premature implant failures and or post op complications. TY Sir…

    Reply
    • Hi David!

      Can I get by with harm reduction and simply lessen the amount of vaping/drinking/smoking, etc. post-surgery and still reasonably expect a good outcome?
      Yes but it must be less than 3 cig equivalents per day.

      Is switching to vaping post surgery preferable if unable to quit entirely?
      Vaping is just as bad ;-(

      Should an inability to quit these habits entirely preclude one from being an implant candidate?
      No, but you have to be prepared to have problems/failures/revisions of dental implants.

      Sorry for the delay. IT had my site down for more than a month! ugh!

      Dr. Amin

      Reply
  28. Hi there! I couldn’t find a question quite like this but sorry if it’s a repeat. Two days ago I hade #9 extracted with a bone graft. It was covered by a collagen membrane I believe. The membrane appears… smashed? I’ve not eaten much and the stitches are still in tact so I don’t believe it’s actually compromised but I’m concerned about the days that follow.
    Thanks!

    Reply
  29. I had a bone graft done almost a week ago. The stuches broke and the membrane is exposed and at times almost out. What do I need to do. I still have the same amount of pain today then I did the day after surgery

    Reply
  30. Hi I had 2 implants implanted 1 mo with the hope of building up enough bone. I was told to come back 2 weeks later for stitches removal which I did. At this point I was told to come back in 2 weeks for membrane removal. This was news to me but I did as told. It took 3 assistants yanking so hard and causing pain (it was tacked into place) that they decided to put novacaine in to get it out. Someone came back in as the area was numbing and said change of plans. The membrane should stay in. They assured me it didn’t budge from all their pulling but when the numbing went away and I had a good look, it has come loose instead of lying flat, and now it is puckered and coming up through the opening. I now believe this was to stay put through the next 4 months to build up bone. My doctor won’t be back for 5 days but I’ll see him then. Is this a major problem that will cause my implants to fail? What do you predict would be the next step?

    Reply
    • Ugh. Not good. It sounds like you have a traveling doctor rather than one that is there all the time 😐
      Keep me posted. You might have to have this redone

      Reply
      • Meaning adding more bone fragments, laying down another membrane and stitching it up again? The implants are in place. I’m assuming at least those can stay?
        Is it ok to wait for my dr to come back on Tuesday (6 days after it was dislodged) and keep my care with him? Or is time of the essence and I should just see another dr who is there and can deal with this asap?

        Reply
  31. I had a tooth extraction last Wednesday and bone graph put in . It’s been a week and I notice a white thing hanging down is that normal ? Is it the membrane ? and the stiches already fell off he told me he would remove them in a month is it to soon?? Thanks
    Reply

    Reply
  32. I had #14 removed & a bone graft done at the same time. A membrane was placed at the time of the graft. I went back at 2 weeks to have the stitches removed. My oral surgeon said everything looked good but she likes to keep the stitches in 3 weeks. I went back again today. Some of the stitches were just hanging. She removed the stitches & membrane & told me she wanted to see me back in a month. As I was making my appointment I heard her tell her assistant it’s not healing (but told me everything was ok). I have never smoked or drank & I am not a diabetic. I was wondering what could be the problem. Is this typical?

    Reply
    • You can’t assume they were talking about you.

      Fortunate every wound heals …but some much better than others. Give it 4-6 months before placing an implant

      Reply
  33. I know it’s been a while since you wrote this and I read all the comments but if you could provide a little insight that would be great…

    I had an extraction and a bone graft 8 days ago for #2. On the day of the surgery, I scheduled a follow up appointment for 1 week after to remove the stitches. However, on day 4, I noticed that some of the stitches had come out and they weren’t really holding anything together. I made an appointment for day 5 and the surgeon removed the stitches and said I had nothing to worry about because everything looked fine. She also said that the membrane would fall out in about a week and that I shouldn’t panic when that happens. I made another follow up for 3 weeks later.

    However, my membrane just came out. It’s obviously been way less than a week. It’s also a Saturday and I have no way to reach my surgeon. Should I be worried? Or is my mouth healed enough that the membrane is more of a precaution at this point?

    Any advice would be really helpful since this has obviously been a pretty big financial and emotional investment. I’m feeling a lot of anxiety about it.

    Thanks

    Reply
    • It should be ok…but that is a very early loss if it even is a true membrane rather than just a collagen plug.

      Reply
      • Ok so, you said it should be ok but the ellipses and the mention about early loss makes me feel like you actually have concerns?

        Reply
      • Hi there. I had a bone graft and membranes added on two teeth last Monday. I have been in pain ever since! It has not gone away! I went to do a post op yesterday and she said everything was still in tact. Later that day, something white fell out. Now today, it is like my gum is swollen, and flopping!! Hurts SO BAD. I still have stitches attached (partially)

        We are talking 8 days post op, and still hurts. Makes my entire head hurt, ears and face hurt. Can barely eat anything. She did put me on an antibiotic yesterday.

        Is the flipping of the swollen gum sound normal to you?

        Thanks!

        Reply
        • ugh…not normal………….BUT…you WILL heal. I rarely have a patient take more than ibuprofen for this and only for 2 days. The anitbiotics seem a bit a late. Hopefully will get better in 2-3 days. Sorry ;-(

          Reply
          • I had #20 pulled for an emergency extraction. Horizontal break at the base where tooth meets gum. It has been just 2 days and this white mesh looking thing fell out while doing a salt rinse. I know I have dissolving stitches. But what could this be?

          • Oh PLEASE tell me how it turned out! I had an extensive graft w/ membrane installed on the upper left side 10 days ago & it has not reduced in swelling or pain AT ALL.
            I went to see the Dr. 7 days post-op & he said it is intact & not infected, but I am terrified beyond measure because it is so tender that I cannot wear temp denture & have to wear a mask in public.
            I would love to know if your surgery’s swelling went down & how it’s doing.
            Today I may go back in to see Dr. because this just can’t be right that I’d be in such excruciating pain, literally 24/7.
            It burns & is painful beyond measure when drinking anything that isn’t warm.

      • Is there a chance that I won’t have enough bone even if we wait 6 months? Will I need to do this all over again? That’s my biggest fear.

        Reply
        • yes…there is always the chance but hopefully just small amount of additional grafting would have to be done at the same time of the implant placement

          Reply
  34. Hello, I had an extraction on #13 last Friday with bone graft and membrane. My suture fell out today and now my membrane is kind of hanging. Should I be concerned?

    Reply
  35. Greetings. I had an extraction and bone graft on #30 on Thursday and all went well. I have been diligent in rinsing with salt water, soft foods, no alcohol, smoking, etc. Of course, I have seen bone granules, as expected, but this Sunday morning it appears my membrane is gone. I received one stitch to hold the membrane in place at the time of the procedure. As stated, It is Sunday and it appears the membrane is gone with the stitch flopping around at the graft area. I can also see the edges of the socket with the granules inside. Don’t know what the stitch is attached to, but it just appears to be there with no membrane. Is it unusual for the membrane to fall out so soon? Should I be able to see inside the socket with the granules visible? Should there be a stitch flopping around at the procedure area? I was told the stich would dissolve, but it appears the stitch is still there with no membrane. I have not had any pain or swelling and have been on antibiotics. Insights?

    Reply
    • Typically I would like to membrane to stay there for 3 or 4 weeks. Generally speaking there is a series of crisscrossing sutures with a few back up sutures as well. A single stitch is not going to hold the membrane in in most circumstances. In general it will probably still heal and repair itself but it may not regenerate as much bone as you or your dentist would like.

      I would go ahead and see your dentist for a follow-up ASAP.

      They can always add more bone at time of implant placement if they are skilled and experienced in this technique

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

      Reply
    • I had a molar extraction with bone graph done 4 days ago. The pain I’m having is radiating to my jaw and I’m able to control the pain. I’m taking 800mg Motrin q6 and Tylenol q4. I went in today and the dr told me there wasn’t any sign of infection and I couldn’t have a dry socket with the graph.
      He said the pain I’m having is normal healing pain and my body is angry with the graph. He numbed me for pain relief and told me that if he had to take the graph out it would leave me in more pain. So he wanted to wait at least 7 days.
      I’m on cipro and doing everything I can to get relief. Is this normal for a graph? Or could I possibly have a dry socket even with a graph? I’m also wondering if I should seek another’s professional advice.
      This is the worst pain I’ve ever been in.
      Thank you.

      Reply
      • 😔oh gosh. Not normal!! What tooth? Must be a lower molar. Cipro is an odd choice. I would switch it to something else. This type of graft causes zero pain. It is the extraction that likely caused all this. Do you smoke?

        Reply
        • hello i had a bone graft on my upper left lateral nearly 6 weeks ago about two weeks ago the membrane started coming out of the bottom of the gum and my surgeon said it was normal however as weeks went by more and more membrane came out and today i discovered that its coming out of the side of my gum as well where the thickness of the bone was added. Is this a failed bone graft or should everything be normal?

          Reply
  36. I recently had two premolars removed several days ago and the graft sites are sunken in when compared to the high points of gum tissue on either side if the graft. Is this normal or are they underfilled? Can they be reopened and more graft material placed?

    Reply
  37. Need an implant on tooth #11 not certain if GTR is necessary since bone graft will be done. Will bone graft suffice or will GTR really make a difference on that tooth? Is it critical for me have both done?

    Reply
  38. I did socket preservation #5 & 6 with Foundation 3 months ago, and it didn’t work. Two days ago I grafted with a mixed of mineralized bone & calcium sulphate. I put a non resorbable membrane.
    I closed with Vycril after releasing periosteum. How long Time could I leave the membrane?

    Reply
  39. Dear Dr. Amin,
    Several years ago I had an implant placed on my front “fang” tooth. I had to have a bone graft done. About a year after the completion I began having a strange pain above the implant (in my gum) and when I rubbed my finger along the gum I felt a very sharp object sticking out. At the time I thought it was a piece of bone. I have since been dealing with the pain and the ‘bone fragment’ sticking out but recently went to my regular dentist to have other work completed. He took xrays & shockingly said “What the…The surgeon who did this implant left 3 tacks in your mouth!!” Now I know what the sharp object sticking out was & why I am experiencing pain! Does this happen frequently?? What should I do? Thank you so much for any advice you can offer. God bless you.
    Michelle H.

    Reply
    • Tacks are fine to leave. They rarely cause a problem.

      In your case it might be the cause of your pain but unlikely. They are fairly easy to remove through very minor surgery

      Reply
  40. I had a molar extraction and bone graft done Friday, Jan 3. The next day, i rinsed my mouth (no swishing or spitting), and just let the water fall out of mouth. I noticed a seemingly substantial amount of white granule substance. I am to go back Friday to have stitches removed. Was this my entire bone graft falling out? Should i call tomorrow, Monday, vs waiting until Friday?
    I also requested antibiotics, which were prescribed, but would not have been if i did not request.
    Is any of this sounding worrisome/abnormal? Thanks.

    Reply
      • Thank you. I feel like DDS is newish. Also, i declined a filling because he said could turn into root canal..an extraction and possible RC on same day?? My mouth was sore enough from being open so long…i can certainly have RC on ANOTHER day. OMG. I also had pain with extraction/sutures. Not numb enough, even after several shors. And the shots were excruciatng. Good way to fill me with DDS fear, which I never ever had prior. Thanks again…i wish I could see you!!!

        Reply
  41. I received a bone graft prior to implant surgery. The membrane fell out the 8 hours later. Does that pose a problem? What I have read it should usually take 1-2 weeks for this to happen.

    Reply
      • Hello.

        I had a similar problem as Shawn above, but my dentist told me all was fine. I am not convinced.

        On Friday (04-03-20), I had an infected #2 tooth extracted, bone graft put into infected (but cleaned) socket, and a membrane stitched on top. A new appointment was scheduled for 05-08-2020 (only one month away), for an implant.

        About 12hrs later, I gently rinsed after drinking liquid food, and the membrane dislodged! A lot of graft particles came out! The remaining graft material was very low, well below the gumline. The membrane flap was very mobile, sometimes it would go back into the socket, and sometimes it would sit on the stitches (like in a hammock). I called dental office next day (Saturday morning), no one answered, so I left a message.

        I called again on Monday (04-07-2020), the dentist had me come in right away. He took an xray, and removed the stitches. He said everything was ok, but I didn’t think so. I told him a lot of particles came out. He showed me my (before & after) xrays — the gaping hole after removing infected bone, and compared it to this visit. He said the graft “took”. I think the x-ray image simply showed the remaining compacted particles, causing it to “appear” okay.

        Today I noticed the membrane vanished, and I can clearly see the particles in my socket. The particles are even lower now, and gets lower each day. I believe the particles will completely fall out, well before next month’s appointment.

        Occassionally I have brief minor pain, that lasts only a minute. So pain is not a problem so far.

        1) Is it safe to wait until my next appointment, which is a month away?
        2) Can a bone graft still partially take, even in this situation?
        3) Why was only one month given for a future implant? (Doesn’t it take several months for a graft to be ready?)

        Thank you in advance.

        Reply
        • Please delete or disregard my previous comments/questions. My DDS has explained everything more clearly. Sorry if I wasted your time, and thank you.

          Reply
          • No waste at all. This helps others. What did they say? It is a bit unusual to have a bone graft during COVID -19 though. You may want to read this helpful article. Stay safe!

  42. Hello! I had an extraction and bone graft placed on tooth #5, December 6th. My implant specialist placed an exposed ptfe membrane over the graft. Things have been going well, only I am noticing the membrane has some gray spots on it, now. Is this ok? I don’t have any pain, but I do sometimes have a sour taste on that side of my mouth, that diminishes after brushing. Thoughts?

    Reply
  43. Dear Dr. Amin,

    Thank you so much for this excellent blog that explains the knowledge and answers our questions in such a detail. I greatly appreciate finding this blog and please keep up the good work! I had a tooth extraction, bone graft, and membrane the day before yesterday. Yesterday evening I noticed bits of white particles in my mouth. This morning I found a piece of white tissue paper like material stuck on the side gum of the tooth. Upon closer look, I realized it was the membrane. The dentist’s office told me that the office won’t open until tomorrow and the doctor will see me first thing in the morning; in the mean time I should bite down on gauze all day and only consume liquid like Ensure until tomorrow. Good I found your blog to read up on, and now I know what those particles were. Thank you! I have the following questions:

    1. The gauze I was biting firmly on, still showed blood. Is it normal for the 3rd day?
    2. You said antibiotics must be prescribed if the bone graft was not from my own body. I know it was not from my body although they never said what type it was. However the dentist didn’t prescribe antibiotics. Should I request antibiotics tomorrow? If he would not prescribe, what should I do?

    Thank you very much for answering.

    Reply
  44. Dr Amin, In the case of a #31 extraction and bone graft do you use a membrane or collagen plugs? Which is better? Do membranes allow the socket to contain more bone graft material than if a collagen plug was used and is it preferable to have more bone graft material?

    Reply
  45. Dr Amin, In the case of a #30 extraction and bone graft do you use a membrane or collagen plugs? Which is better? Do membranes allow the socket to contain more bone graft material than if a collagen plug was used and is it preferable to have more bone graft material?

    Reply
  46. My oral surgeon informed me that the membrane he placed during my extraction and bone graft may fall out on it’s own. I have a follow up on Wednesday and the membrane still seems to be pretty snug. I can see it on the inner gum line as well as in the socket…my question is, if he needs to remove it will I be numbed? I am terrified it is going to hurt and I am already a big baby when it comes to dental work. Thanks!

    Reply
  47. Very interesting to hear of all the membrane materials being used, but this comment did it for me; “ultimately the surgical technique, training, judgment, and expertise of your dental implant specialist is going to be the most critical factor in the success of your bone graft…choose wisely!!!!!!”
    I am not leaning towards getting a flipper for a temp. Are temps necessary for any reason other than appearance? You posted this to another comment; “here is a post that should help… Talks about temporary options” – but I did not see a link to it.

    Reply
  48. Hi, I had to have my right front tooth pulled due to bone resorption. It is thought that this all started years ago when I fell and knocked my baby tooth out. It’s thought that it caused root damage that lead to my problems with it as an adult leading me to get it pulled. In February 2018 I had it extracted and he placed an implant along with a bone and membrane graft. Everything went okay as far as healing but as feared, my gum receded and it was noticeable above the temporary crown that is attached to the implant as well as some loss of gum between my front tooth and the tooth right next to it. I just went back at the end of August/early September to get fitted for my permanent crown but we decided we wanted to do a bone and membrane graft to try and improve the appearance of my gums so the permanent crown has been put on the back burner which is fine. I had the bone and membrane grafting done on Saturday (9/8/18) and just went back today for a follow up and possibly get my stitches removed. Unfortunately, the stitches came loose and bone was exposed at the incision site and then again at a site where the stitches had been. I am hoping and praying that this is a minor issue and that my gums don’t just dissolve and disapper- I’m being a little dramatic. This whole process has been traumatic for me because I have never had to deal with this before and it has greatly reduced my confidence as I have always had great teeth and a great smile. Please tell me that the bone exposure sounds normal and that it will most likely heal well. They went in and took the sutures out and resutured my gums in hopes that they will come back together and heal right.

    Reply
      • Thank you for your reply! I have an update on the situation. It’s been 2 weeks and on the dot since I’ve had my surgery and I’ve had to go back in a total of 3 times since then due to my gums dihiscing at the surgical site where he placed the bone and membrane and also the membrane poking through on at the other end. I’ve had a lot of doctor in my life recently and I’m overwhelmed. He placed a Resorbable membrane with a very powdery/hard bone graft- not sure the exact type. The bone part of this whole thing seems to be fine. I’ll start from the beginning since the surgery with the chain of events. Had the surgery the 8th of September, Went in to have stitches removed on September 13th and found my gums had dehisced, so more stitches, went back in on the 15th because guess what? More gum tissue in a different area had come apart exposing bone, had that resutured, then I was saw AGAIN on the 17th and had to have my gum sliced back open to trim the membrane back on the other end of where he inserted it and then resuture that area along with having to resuture the gum yet again in the area of where he inserted the membrane because of bone exposure again (not sure why my gums are so friable in that area). To say I’m mentally and physically OVER it is an understatement. Since then, It’s been all fine and dandy in the area where he inserted the membrane because it’s healed well, the stitches are basically hanging there and as far as I can tell there is no more bone exposure. However, my membrane on the opposite side is pushing farther through my gums than it ever has (above my temporary tooth). I know he’s going to have to either take it out or trim it down again and I hate that because he has to numb the roof of my mouth because I’m so sensitive in that area and honestly one more of roof of the mouth shot might just send me over the edge. I think the reason they haven’t done what you suggested is because one, the biggest issue we have faced is bone loss and they are worried about not having enough bone to attach gum tissue to and two, I refuse to go without a front tooth. I’m just not going to do it. I’m a RN and deal with patients on a daily basis and I just refuse to not have a tooth lol. I’m getting to the point where I don’t even care what that area looks like but I think it’s just because I’m so overwhelmed by this whole process I’ve been through lately. I’m tired of having a sore mouth. 😩 Any suggestions you have are appreciated! Believe me when I say I know how hard it is to give advice without seeing someone in person!

        Reply
        • Ugh. I’m really sorry you are going through this. In almost two decades of doing this I have never RE sutured someone….it doesn’t help.

          Remove membranes and sutures and just let it heal on its own.

          I’m not saying what you are having is wrong…just different.

          Reply
  49. I recently had implants for #8,#9 and a bone graph on the front dome on a Wednesday. Saturday evening the stitches came loose and now the membrane packing is barely hanging on. I have very little swelling and no pain. Should I be concerned?

    Reply
  50. Hi,
    I had full dental implants a year ago. I recently had a bone graft, done approximately 3 months ago. I noticed my
    upper left gum has disappeared. The dentist had no explanation. What does this mean? Now, he wants to remove the dental implants, place longer ones in through my cheek.

    Reply
    • Hello,
      I had a extraction and bone graft done on my tooth three days ago. Day one my stitches came unwrapped a bit and on stitch that came through my gumline was hanging loose in my mouth. Day two that stitch dissolved and I guess all the others did too as I cant see them at all, and what I’m assuming is the membrane is hanging down like a tooth now. I havent had much spilling of the bone graft material but how loose everything is concerns me. Day 3 now and the gum is black around the extraction site (which im assuming is a clot and a good sign) with white bits around it, also think thats good but my concern is the hanging membrane is also turning black now like its soaking up liquid. Should I be concerned? I can’t contact my dentist until Monday.

      Reply
  51. Hi,
    I had a have significant bone lose on my upper tooth after extraction. I had a bone graft done 2 weeks ago but it has been smelling lately and there is a lot of spongy white substance hanging down with no gum or membrane.I have one more day of antibiotics and wondered what I should do? I have also been wearing my flipper because the dentist said it would be fine, I take it out at night though. Any info would be very much appreciated.
    Autumn

    Reply
      • Hello, my boyfriend got his tooth #5 extracted a little over a week ago. They did a bone graft, placed a membrane, and sultures. Almost immediately he could feel the membrane, as it felt like something stabbing through his gums and he dealt with intense pain. He went back in and they removed the sultures, and adjusted his membrane. He’s been dealing with the pain off and on again for the rest of the week, but today the membrane fell out when he was swishing.

        He’s panicking, because he can feel his jaw bone through the hole. Do you have any suggestions for what to do next? This place he goes to has a history of not quite listening to him regarding his symptoms (which is making me VERY angry) but it’s the only place his insurance allows.

        Reply
  52. Hello,
    For an implant, I had #13 extracted Thursday at 10am. I also had a bone graft done. It’s now Saturday. The membrane, which was completely visible and in the spot of where my tooth had been, was slowly drooping and falling out all day yesterday. I noticed it after I eat. Now it’s almost completely gone. I can see the stitches but nothing else, just my gun in the absence of the tooth. Is this normal? I haven’t had any bleeding, pain, or discomfort. My follow up appointment isn’t until next Thursday, when they will remove the stitches. I am on amoxicillin and a soft diet. Also, is it ok to practice hot (bikram) yoga? Thank you!

    Reply
    • Hi Laura. I have the exact same question! Extraction/implant/graft/membrane on #13 Thursday. Last night the membrane came out. Today is Saturday and am waiting for the on call dentist to call back.
      No bleeding/pain/ swelling

      What happened to you? Thanks!

      Reply
  53. I had # 8 extracted and a bone graft done. There is a large “mound” behind the tooth? What is this and will it go away? Also, I wear a flipper and have some discomfort when I place it back in my mouth as it hits the mound on the left side of my mouth. Should I be concerned about this?

    Thanks in advance for your help

    Reply
    • Yes….concerned….
      I am not a big fan of the flipper type of temporary but it does work “okay.” I do not use them as my primary form of temporary.

      The part that I am concerned about that the flipper touches this mound. If it is exerting any pressure whatsoever you can develop a dehiscence/failure of the graft. You need absolute immobility of the bone graft for it to actually heal. This bump is probably some extra bone which is a good thing. If it is still present in a few months from now it can be trimmed down but having extra is always a good thing. I would see your dentist ASAP and have the flipper relieved so there is clearance between it and the underlying gum.

      Reply
  54. Hello, I had surgical extraction of #15 with bone graft on Wednesday. Today(Saturday), the membrane fell out while I was eating breakfast. Do I need to contact my oral surgeon and if so how soon? Thanks

    Reply
    • Yes I would contact them on Monday. Ideally, the sutures do not even hold the membrane down. Typically I tuck it underneath the gum on the inside and outside. The stitches are just insurance because once the gum tightens it grabs the membrane and hold it down without stitches. Everybody has different technique and different skill set and of course each person is unique. Just avoid any heavy rinsing and be gentle with the area until they can look at you.

      Reply
  55. I have a friend that sounds like he had a big area of bone removed with a maxillary molar extraction; bone
    grafting (sounds like freeze dried bone), was placed and then a membrane; on top of that, there was a
    plastic mouth guard that was made to help hold things in place (never heard of this); not sure how experienced this Dentist is; my friend has been through a lot to have this completed; at the time, the assistants
    were unsure of what type of guard the Dentist was wanting – is this something new? Couldn’t a dressing have
    been placed?

    Reply
  56. Hello dentist! Thanks u to doing this , I am 34 years and my lower front teeth I wore bridge many years , now I decided to do implants one teeth that I born without it . Dentist told me I need a bone craft, so he surgery and put bone cover with membrane, the 2 weeks the membrane is come off and now I am wearing temporary bridge. I address that to him but he says ok and come back 3 months to do implants,. What my concerning is the day fall off I see some off the bone material too and now nothing to cover it . Do u think is sounds right cause I am not trust him cause the last visit he didn’t exaray but he said OK. Please advise. Thanks again for ur time

    Reply
    • In this article I discussed when there are times where some exposure is okay. All depends on the technique of bone graft was done not so much the material. If the graft is still exposed I would let it heal longer. There is no race to the finish line… Often going slow or will help things mature and create cortical bone again.

      Reply
      • doc I have an implant screw only for two months now and I am having ear popping.I saw my dentist and I want not to continue the process of putting abutment and dental crown.In short I want this implant to be removed.if they will removed this are they going to do bone graft?or the hole will heal on its own?

        Reply
        • There is no correlation between the two (unless you are biting prematurely on the implant itself). Perhaps something else is causing the problem. Did you have any other dental work done at the same time such as a filling that could throw your bite off?

          Reply
  57. Thank you, I read the article and it cleared up all my questions and gave me insight on several other thoughts. I’m having a full upper implant. I trust my dentist completely. You reaffirmed my trust in him. I was very sure he had my best interest at heart.

    Reply
  58. Hi Doc,
    What type of bone graft material or materials (cadaver, cow etc) do you use on your patient with tooth #8 and #9 if your patient has zero bone left (from using denture) and without using patient’s own bone?

    Reply
  59. Thank you for answering so many questions.

    I had my two front teeth removed with artificial bone grafting and a non-removable membrane put in. I was seen last week and it was felt to be healing slowly but well and I had some soft red gum over both sockets. Today I’m shedding graft particles again from one of the sockets. No pain, systemically well but it’s over the holidays and the only dentists avalible don’t have implant experience.

    Is this within the normal healing process?

    Reply
  60. I am a dental hygienist and unfortunately I am not a stranger to dental issues. I have fractured several molars in the past and had to have them extracted. My restoration of choice has always been to place dental implants. My first implant was on #19, then #30 and most recently I fractured the palatal root on #3. I recently had the tooth extracted and bone grafting done and for the first time they placed a membrane. It seems that during the extraction there was more buccal plate removed than was expected while trying to remove the mesiobuccal and distobuccal roots so they opted to place the membrane over the bone grafting material. For what ever reason they used semi dissolvable sutures not cat gut but something else, instead of silk sutures. There were 4 sutures placed which I felt was sufficient to hold the membrane in place and protect the bone graft, but less than 12 hours later 2 of the sutures were gone. Literally gone…it was the weirdest thing and I could feel the membrane hanging. I went back inthe next day and he replaced the missing sutures with 3 more to stabilize the area, but now you should see the swelling I have. I have never been swollen like this before, and my cheek is very warm. I am on 500 mg of Amoxicillin 3 times a day for 10 days and I am doing cold compresses and salt water bathes on the right side to promote healing, but geez this is weird. And now I feel like the membrane is “melting” like the wicked witch of the west in the Wizard of Oz. Is that normal? Tiny specks from the bone graft are everywhere. Exactly how long should the membrane last? I know that there is a good possibility of having to have a sinus lift and add more bone grafting material before we can place the implant so if some of the grafting material is lost we can replace it then, but my concern is the swelling and the membrane. Any suggestions that might help this healing process? Thanking you in advance for your reply. Sincerely, Concerned RDH, BS

    Reply
    • Upper molars are far more complicated than lower molars. A much better suture is a non-dissolvable D PTFE suture which is bright white. Obviously good technique is critical.

      I would consider applying a blood product made from you called PRF directly onto the site and possibly do brining the graft if necessary. If you have extended pain or swelling, maybe repeat 3-D scan and definitely adding on a second antibiotic such as metronidazole will help. You can also do a culture and sensitivity if infection is substantial and is still continuing.

      I hope you heal up quickly!! Please update me and reminded me of your original story. It is easy to remember the hygienist!

      Reply
  61. I have a cracked tooth on the top left side of my mouth, Second tooth from the back. My dentist is going to extract the tooth and perform the collagen procedure, as well as inject collagen on two other teeth that have exposure, is this all done at the same when tooth is extracted?

    Reply
  62. I had an extraction done to tooth # 14 on Saturday, with bone grafting, for future implantation consideration. On Monday, membrane fell as stiches came lose. On Tuesday, (today) the dentist said the bone was not bothered, and he restitched a new membrane. Tonight, I can feel the stitches came undone, again, and the membrane is starting to hang, again! What would you suggest that I do at this point, as I do not foresee the stitches lasting, and my mouth is so very sore already from the restitching! Thank you so very much for any advice.

    Reply
    • restitching never works. This is not a technique that I would advocate. You’re just going to need to give it time at this point. Sorry

      Reply
  63. Tooth #18 which had a root canal and crown done less than 5 years ago failed and shows infection which is probably into the bone or very near being i saw that little pimple for drainage out the side of the gums a few weeks ago, well it needs to be extracted.
    Whether it needs bone grafting or not , i don’t know, im trying to just trust the dentist knows best, but when insurance wont even cover a procedure other than extraction it makes me wonder if it is critical and or necessary otherwise why do it.
    I do not foresee getting an implant anytime in the near future, if ever at all (unless by odd chance winning the big lottery jackpot lol one day)

    Anyhow, im really annoyed that i wasnt able or rather even allowed to have a talk with the female oral surgeon about the procedure first. Not until i first pay the 500 dollars out of pocket for the bone graft.
    Im hoping i will at least be allowed to get her name when i call the office tomorrow and if not, well i will have to go elsewhere, but unfortunately they cant help you with this kind of problem at the local ER at a hospital.
    Which only goes to help show how easy it is to extort money out of someone in my predicament

    Reply
    • Sorry for your bad experience. Dental insurance has not changed in more than 40 years. It does almost nothing. It covers the most minimal and basic treatment such as cleanings and exams.

      Reply
        • I got my front tooth extracted and bone graft with membrane right and stitches right after. I was told the stitches will dissolve on its own. It’s been only five days and my stitches are falling apart and some membrane fell out and some is hanging out with a little stitches attached. Is this bad? I have seen any bone graft just the membrane. I’m worried I won’t have enough bone for when I get my dental implants in a few months. Please tell me this is normal.

          Reply
          • I would not consider this good healing but it may do just fine. Every situation is quite unique. Consult with your dentist and make sure you go in for a follow up this week.

    • Well this is my question and also does bone grow back? I had a tooth pulled on my left side Year she ago and they are doin a implant on that one without a bone graft so what’s the difference? I also had infection on that tooth years ago? Does time heal it to where you can get a implant later without a bone graft?

      Reply
      • Not all implants need bone grafts. Each area is different even in the same person on opposite sides of the mouth. Even adjacent teeth to the area have different needs. Each situation is extremely specific.

        Reply
  64. I has a tooth extraction and bone graft to preserve the area done about 3 days ago. After only 2 days the stiches became very loose and came out. I’m now at day 4 and a very large portion of the membrane is showing. It seems to still be some inside of the gum as it is not “falling out” and I can’t see a “hole” in my gum but it’s very concerning because I am not worried about complications. Should I go back to my dentist to examine this or will it be fine? Thanks for any help.

    Reply
  65. Hello Dr Amin,

    First of all, thank you for doing this. I had a bridge between tooth 7 and 10 that came off after 24 years. I had tooth 8 and 9 removed back in 1989 but tooth 7 and 10 have had root canal and are only partially visible.

    One doctor told me he can put a new bridge by pushing the gums and exposing teeth 7 and 10 little more. Other Doctor have said that there is no way a bridge will stay there, so he wants to extract those and put implants. He also said that there is not enough none density, so he will have to do bone graft. So far so good. He did CAT scan last week and now he is saying that he will have to insert a membrane that’s going to swell the gums, so he can add more bone graft. Does this make sense? Should I go with a bridge on existing teeth? I am 56 years old and in good health.

    Thanks for your time. I live in Chicago area. Can I call you for any advice?

    Reply
    • natural teeth in the front of the mouth support Bridges very well as long as both anchor teeth don’t have root canals. Your situation needs to be evaluated in person to see which option is most viable. Sometimes extending the bridge from tooth #6 to tooth #11 and avoiding all implants is sometimes the best answer while other times grafting some bone and using a membrane can create a more predictable and long-term solution.

      Reply
  66. My 15 yr old had her wisdom teeth removed. Several weeks later she complained of mouth pain. Her regular dentist took xrays and foreign objects in her gums/mouth. Tacts are what we found out they were. The oral surgeon said said a tooth dislodged and the facts hold the membrane. Is that normal?? Bcuz now he’s asking us to pay to have them removed when I didn’t even know they were their to begin with. Please help.

    Reply
      • I’m not sure and I was never told about it during or after her procedure. She now has to have them removed because they are bothering her. Do u know why a bone graph would’ve been done??

        Reply
  67. I had a extraction on tooth #19 and bone graft placed for me to have a implant in a few months, my concern is what was left of the “plug” it membrane just tell out. It has only been 3 days since I had the extraction, is there a chance of a dry socket happening now? Are there any other concerns I should be prepared for?

    Reply
    • Dry socket typically does not happen on tooth 19. The main concern is that you may or may not lose bone volume and density from the graft since the membrane was lost early. This is how dependent on technique and materials used.

      Reply
  68. I had a bottom molar extracted and bone graft three weeks ago. Rather that the hole closing over, it has gotten bigger. I went back to the surgeon and saw a nurse who said I have lost some of the graft. I am concerned that the hole is getting bigger, so big I lost a tic tac into the hole! They have looked at it again and now I have been given a syringe to irrigate it myself which is a relief. They say they will re X ray in a few months to see if there has been enough bone graft left to take.If not they will go back in and do a second graft. Why can’t they re do the bone graft now while it is wide open? And why is it not closing over?

    Reply
    • There are times where secondary bone graft is needed and is often suggested. This can definitely be done at the time of implant placement and may in fact be the best time.

      In my own practice if this is something that is unforeseen, the patient is not charged a second 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
  69. I am getting ready to go through this. I am a bit afraid and confused by the various methods and terminology. Thank you for your dedication and for taking the time to provide this very valuable information. I now have a better idea of the questions that need to be asked and a realistic interpretation of what needs to be done and how long it will take. Thank you … thank you!

    Reply
  70. I had bone augmentation surgery done in the upper back jaw some 7 weeks ago. It was to provide bone sufficient to take one or two implants in around 8 months time.
    Graft material, I’m not sure what, in the form of white granules was packed into the cavity drilled into the existing bone, and a dissolvable (resorbable) membrane placed over the top. However, I have been in pain ever since! It seems some of the small white particles have found their way past the membrane, and my dentist says it’s these that are causing the pain. I’m not convinced that the dull toothache type pain I’m experiencing is due to this.. He has removed some of these loose particles over the last few weeks, but I still have a dull almost constant dull pain in the area.
    Please can you suggest what can now be done?
    Thank you

    Reply
    • Something else may be going on. I would suggest another X-ray. Be sure that another nearby tooth isn’t causing all this pain. It is possible that the graft isn’t taking also. Pain should be zero at 7 weeks.

      Graft particles would not do this. Was this a socket graft or sinus lift??

      :-). RA.

      Reply
      • Thank you.
        I myself was convinced it was not the particles that were causing me the pain.
        It wasn’t a sinus lift, but I assume what you call a socket graft i.e. a cavity was formed in the bone by drilling into it, and filled with the material. I have now had a 2D x-ray done yesterday, which shows a dark area next to the surgery site, which my dentist thinks is an infection. It’s being treated now with an anti biotic.
        The surgery site is right next to a recent implant/crown, completed a few days after the bone surgery, this implant feels ‘numb’, This implant is very close to the ‘dark’ area shown on the x-ray, I am not sure if this is relevant or indeed normal.
        Thank you again.

        Reply
      • Update on my problem:
        My dentist (who conformed he carried out an external sinus lift graft, not a socket graft), has opened up the area in question and inspected the small dark area shown on the ex-ray that I mentioned in my original note. This area is right next to the graft but not part of it. He found no infection. I have also just completed a course of anti-biotics (known here in Spain as Rhodogil), I have also had a course of penicillin (known here in Spain as Amoxicillin), taken around 5 weeks ago. They had no effect of my problem of an almost constant dull pain in that area..
        My dentist is reluctant to remove the graft, as he says he can see nothing wrong with it on the x-ray.
        If I have an infection of the graft would it show up on an x-ray of any type?
        The bone graft was carried out 2 months ago now. If I have it removed, is it now important to get it done ASAP? BTW The dentist says the membrane has started to dissolve, .
        Is it an easy process to remove the graft, knowing that it was done 2 months ago?
        Thank you.

        Reply
        • I reply to you in another post but if the graft is doing well it has already begun healing and may become more difficult to remove because it is fusing to your own natural bone. If it is infected, it will come out very easily. Make certain you’re sedated for this procedure if you have to remove a sinus graft. It can be extremely painful should this occur. I have not had an infected sinus and probably 10 years and I do this procedure multiple times a week. I hope you’re healthy and do not have any medical problems or smoke

          Reply
      • Update on my problem:

        I still have an almost continual dull pain in the area of the graft.

        My dentist confirmed he carried out an external sinus lift graft. On a 2D x ray he noticed a small dark area just next to the bone graft. He has now opened up this area and found no sign of infection. He still thinks that I probably have an infection and prescribed a course of anti-biotics (known here in Spain as Rhodogil), I have also had a course of penicillin (known here in Spain as Amoxicillin), taken around 5 weeks ago. Neither has had effect on my problem. He is now going to refer me to a ENT specialist for advice on what other anti-biotic to use.

        He thinks the numb feeling I am experiencing in the implant/crown adjacent to the bone graft is due to the infection he thinks is there.

        I now ant him to remove the bone graft, which he is reluctant to do because he says its healing OK. But agrees that somewhere in that area he thinks its infected!

        The bone graft was carried out 2 months ago now. Is it still possible to have it removed easily and what are the risks? Is it now important to get it done ASAP, or can I afford to wait another 2 weeks say, to get a ENT specialist opinion? BTW The dentist says the membrane has started to dissolve.

        Reply
        • a 3-D x-ray is necessary and generally speaking I would suggest a combination of amoxicillin and metronidazole taken simultaneously for 10 days. I believe the medication you mentioned is metronidazole. 500 mg each if there are not any contraindications. metronidazole needs to be taken with another antibiotic at the same time 4 to be effective. 2-dimensional x-rays at this point is not sufficient. Numbness can occur in this area from the surgical flap. Typically there treated with steroids at the time of surgery and sometimes afterwards. The numbness is not typically from an infection in the upper jaw but sometimes this phenomenon happens in the lower jaw. Of course I have never seen you before so this is not actual medical advice… I hope it helps you. Keep me posted. ENT may prescribe you a very strong antibiotic, Levaquin

          Reply
  71. Hello
    I had tonsil cancer 10 years ago (RADIATION AND CHEMO)
    The last two years I have lost two teeth left side far back of mouth. I cannot have an implant no bone in upper back left
    I need to have 3 teeth extracted upper right back the bone deterioration gone. I just had a bridge done there 6 months ago that has been destroyed
    what are my options ?
    I have seen different people my bottom teeth are solid my top and bottom teeth between my lips from nose to chin are solid
    should I have all my teeth pulled on top and do dentures ?
    I would love to do implants but im told i do not have enough bone this is not an option I have been told this will not last by 2 different professionals
    i have an implant in front tooth number 8 for 15 years and looks great
    Very concerned on what I should do
    from Athens GA

    Reply
    • Merry Christmas,

      First off make sure the radiation did not hit your upper and lower jaw. This can be confirmed with a port film from your radiation record. Radiated bone can be very slow to heal and a condition called osteonecrosis of the jaw can occur from surgery done in that area of heavy radiation.

      Bone can be easily rebuilt. I suggest you go for a third opinion.

      The upper left back bone is extremely simple to rebuild usually with a sinus lift bone graft. If needed, block grafts were bone expansion can be done to gain enough bone for dental implants. I have rarely seen a case in the last 15 years that truly nothing was possible. Oftentimes, extensive grafting can become cost prohibitive depending on each person.

      Should you decide to remove all of your teeth, computer guided surgery can help the dentist utilize your existing areas of excellent bone and avoid the areas that do not have enough bone. I commonly, extract all teeth and replace them with a Prettau dental implant bridge. Most of the time, the bone does not need to be grafted because of the unique position of the implants placed slightly deeper and closer to the tongue. Most people have good bone in this area.

      Each situation is so unique that there is no way I could answer what is best for you. I wish you lived to closer

      Respectfully,

      Ramsey Amin DDS

      Reply
  72. this article was really helpful as i had my tooth number 8 removed for implant , and then cover with a PRF so now i’m more informed.

    Reply
  73. I need to have # 4 extracted which is supporting a bridge. I have been told it needs to be extracted because it has a cavity under the crown that has affected the bone slightly as per x rays and destroyed the tooth under the crown. One option offered is to extract it w/o removing the 5 tooth bridge and leaving the bridge with only two supports on my own teeth #’s 2 & 6 and two pontics in 5 & 3. If I send you a copy of the #4 x ray and an Icat 3D cone beam xray of my mouth can you suggest other options? I’m looking for the MINIMUM invasive solution since although I’m in excellent health I’m in my seventies. I was thinking of replacing the extracted #4 with an implant at same time and then replacing the bridge but have been told its not wise to have a bridge between natural teeth and implants although some dentist do it and now you can get bridges made with no metal just porcelain which are strong and more FLEXIBLE like Bicon’s Trinia. Another idea is implants on 5 & 3 and a 3 position bridge between them with 4 as a pontic. The problem seems to be there is a need to do a lift for 5 which I don’t want to do. I see 5 mm of bone here based on the 3D xray and thought possibly a 5 mm bicon would work here or a soft tissue level implant to avoid the lift and just have a common implant w/o additional complications.
    Your aseptic procedure its superb. Congratulations! You are a cutting edge Dentist and a pioneer in this very special process of implantology that many think anyone can do.
    Looking forward to your response.
    James

    Reply
    • Thank you for your very kind words James

      The upper jaw has very soft bone due to a high prevalence of bone marrow. The upper back teeth undergo a tremendous amount of force. It is a recipe for disaster with high bite force in soft bone.

      Placing a 5 mm long implant in the upper jawbone Is not recommended. It will fail miserably very quickly. The upper Jaw needs implants that are longer. 5 mm is a good diameter but not a good length.

      A sinus lift bone graft is truly an extremely predictable procedure done since the mid-1970s. It is highly dependent on the skill of the surgeon.

      Without seeing you in person I cannot tell you what exactly to do but I would not do any flexible type of bridges. Deafly do not connected natural tooth to an implant either.

      Even though you are 70 years old, do it right. If not you will only be removing all of this and wasting a bunch of money.

      Good luck my friend

      Reply
  74. Hello. I had surgical extraction of #9 with a bone graft consisting of cadaver bone, my own bone, and a membrane. Granuals were used. This procedure was 5 days ago. Yesterday, my stitches started coming out. Now, I only have 1. Today, on 2 separate occasions, I have had 1 granual come out onto my tongue. After the first 1 came out and I realized what it was, I panicked and grabbed a pen light to take a peek. Where I had my extraction and implant is open and I believe I see the membrane. The tissue looks good and healthy and I don’t believe I have an infection. It looks remarkably healed, actually, for day 5. Should that area be closed? I’m afraid to mess anything up if that should be closed or still stitched shut. I suffered bone loss as a result of multiple infections around #9. If I’m not mistaken, my bone loss was the outer portion of my socket. Do I have a reason to freak out? Thanks in advance!

    Reply
    • I misspoke. Where I had my extraction and GRAFT is open and I believe I see the membrane. Sorry for my error. Also, I guess technically, it is day 6, but I haven’t been to sleep yet, so it doesn’t count! Lol

      Reply
      • No need to panic just yet. 😉
        Some membranes are placed in a way to purposely remain exposed while some absolutely need to be buried under the gum.
        Here is another post that may help you answer some questions
        Ramsey Amin DDS

        Reply

Leave a Comment