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Bone Graft Membrane Sticking Out And Exposed

Do I need a membrane for my dental implant bone graft? 

socket membrane

Ramsey Amin DDS 

membrane space




(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 that come to see me in Burbank, California.

My membrane fell out or is sticking out and exposed!

Purpose of Membrane For Bone Graft

A membrane is a barrier 

membrane ramsey amin dds

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) membranesBurbank Dental Implants 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 Membrane is 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 membrane that is sticking out 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


142 thoughts on “Bone Graft Membrane Sticking Out And Exposed

  1. 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!

    1. 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 ;-(

  2. #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?

  3. 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.

    1. 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?

  4. 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?

    1. Gosh.. So sorry you have some much pain. In my practice I truly only see this about 1% of the time especially with a simple procedure like this but I do things quite differently than most dentists. If the pain goes longer than 5 days have an x-ray taken, make sure there is no infection. If there is infection consider switching antibioticsinfection consider switching antibiotics and perhaps culture and sensitivity to figure out the proper antibiotic.

  5. 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?

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

  6. 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?

  7. 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

    1. 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.

  8. 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!

    1. 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?

  9. 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!

    1. 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.

  10. 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.

  11. 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

  12. 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?

    1. 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

      1. 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?

  13. 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

  14. 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?

    1. 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

  15. 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.


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

      1. 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?


        1. 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 ;-(

          1. 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?

      2. 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.

        1. 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

  16. 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?

    1. read some the previous comments and answers…many are just like yours 😉
      The short anser is likely “no”

  17. 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?

    1. 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

    2. 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.

      1. 😔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?

        1. 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?

  18. 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?

  19. 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?

    1. Foundation is not a great material. I am not a fan of calcium sulfate either.

      The membrane should come out 3-4 weeks.

  20. 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.

    1. 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

  21. 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.

      1. 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!!!

  22. 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.

      1. 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.

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

          1. 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!

  23. 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?

  24. 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.

  25. 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?

      1. Doc after six months i only have screw in my upper molar.i dont want to resume dental implant and put crown is that okay?Im tired of sore mouth?i mean theres a screw inside mouth and its healed already.

  26. 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?

  27. 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!

  28. 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.

  29. 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.

      1. 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!

        1. 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.

  30. 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.

  31. 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.

      1. 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.

  32. 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!

    1. 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!

  33. 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

    1. 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.

  34. 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

    1. 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.

  35. 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?

    1. It may be just a suck down stent to temporarily hold things together. Ask if it looks like an Invisalign retainer.

  36. 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

    1. 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.

      1. 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?

        1. 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?

  37. 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.

  38. 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?

  39. 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?

  40. 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

    1. 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!

  41. 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?

  42. 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.

    1. 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

  43. 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

    1. 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.

    2. 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?

      1. 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.

  44. 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.

  45. 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?

    1. 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.

  46. 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.

      1. 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??

  47. 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?

    1. 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.

  48. 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?

    1. 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

  49. 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!

  50. 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

    1. 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.

      1. 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.

      2. 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.

        1. 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

      3. 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.

        1. 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

  51. 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

    1. 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


      Ramsey Amin DDS

  52. 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.

  53. 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.

    1. 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

  54. 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!

    1. 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

      1. 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

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