Is Socket Bone Graft Necessary?

Is Socket Bone Graft Necessary?

Is Socket Bone Graft Necessary?

Not All Extractions Need Bone Grafts.

A socket bone graft is done at the time of extraction to preserve the bone from shrinking. If the tooth is extracted and left alone, the bone will literally just melt away starting at just a few days after the tooth is removed. The keyword for a socket bone graft is “preservation.” This is called “bone atrophy.”

Pros and Cons of Socket Bone Grafting:

So how do you know if you need a socket bone graft or not? The most critical zone of the mouth where socket bone grafts are extremely important are all of the front teeth to the middle “bicuspids.”This is because the bone on the outer wall of these teeth is much thinner than it is in the molar region.

Keep in mind there is massive variation from person to person on how thick the outer wall bone is. Your genetics play a huge role here. Some people have naturally thick outer walls of bone and some people have naturally thin bone which does not do well for dental implants.

Some Have Genetically Thin Bone

Bone Graft NOT done
Bone Graft NOT done so her bone was lost
Bone Graft Done
Bone Graft Done (not same patient) –Wide bone

Patients that have thin bone tend to have thin gums too and are easily prone to recession around their teeth and or future dental implants. Patients that have thin bone and thin gums, have to be slightly overengineered in order to have long-term success with dental implants. Bone grafting for a person with a thin bone/gum “biotype” is always necessary. The outer wall of bone has to be designed in such a way that it is more resistant to shrinkage. This can be done by various surgical techniques and by using the right bone material for your particular situation. Not all bone is the same!

When the existing outer bone plate is thin, it is almost a guarantee that the bone is going to collapse as soon as the tooth is removed. This is because the tooth root is supporting that very thin wall of bone. So once the tooth is pulled, the bone collapses in order to close the socket. This leaves you with a depression of bone in that area. Without correction or prevention of that depression in the first place, an implant would have to be placed in a non-ideal position instead of in the center.

So what about the molars… those are the teeth that are extracted the most!! On many occasions the tooth being extracted has had a root canal. It may have abscessed and is painful. When an abscess occurs bone is often naturally dissolved the way on the outer surface. If the tooth being removed too infected, and has thicker bone, a bone graft may not be necessary or advisable at the time of extraction.

Ultimately the decision to do a socket bone graft for dental implant depends on the training, judgment, and experience of performing socket preservation bone grafting on a regular basis. Not only performing the procedure is important, but evaluating its results both on 3-D scan and how the bone feels at the time of implant insertion. And most importantly, how does this bone holdup long-term? I have personal experience of seeing the results of these procedures for the last 20 years as of 2020. The techniques that I use work well and last a long time.

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

19 Comments

  1. Keri Berg

    Hi,
    I had a root canal on #30 on August 28th. It failed after taking clindamycin and trying steroids. On September 19th I went to an oral surgeon who removed #30 and placed a bone graft. That morning I took 300mg of clindamycin and rinsed with Chlorhexidine mouth wash.(which I had been using twice a day for a week before the extraction)I had a very bad stomach upset and managed to get 3 doses of clindamycin 300mg in me and phone the oral surgeon.They told me to stop taking the antibiotic but did not call in a replacement which made me nervous. A few days later I had some tenderness in the tooth behind it and they called in the z pack. I had 3 days of the z pack and started vomiting. The next day I went back to my oral surgeon who proceeded to pull the gum back and look for an abscess, nothing was found and I was put back on clindamycin. I again got about a day and a half of the antibiotic. A few days later I ended up in the hospital with an ulcer. I am now doing better, but I am still having jaw pain, socket sensitivity, tenderness if pressure is applied to the gum and a small tender bump on my jaw where the extraction/graft was placed. I had a CT without contrast in the hospital which they said looked fine and I am showing no signs of infection. (no fever, gums not swollen) I am worried that almost 5 weeks out and I am still having pain and something is terrible wrong that is being missed. Could my body be rejecting the bone graft? Could I have an infection in my jaw bone that is not showing signs yet? Any suggestions would be greatly appreciated.

    October 23, 2019 at 6:06 pm Reply
    1. Ramsey Amin

      There is a very good chance that you are not actually allergic to penicillin. You can actually add metronidazole along with a penicillin derivative or use a newer generation cephalosporin type of antibiotic. It is likely that you have some sort of infection that cannot be seen. I would also suggest a probiotic that is yeast based to help with your stomach. Clindamycin can cause something called C. difficile. I try to avoid it whenever possible. I hope you are getting better.

      January 15, 2020 at 8:34 pm Reply
  2. Charles Coan

    Tomorrow morning I will be getting my ( Third) bone graft for my upper left molar. My body apparently absorbed the cadivor bones and the post is loose and coming out of jaw because there is nothing supporting the post any longer. Is it unusual to have this procedure done 3 times !! ?? Since my body keeps absorbing the cadivor bones, is there another option ? Any information on this would be appreciated. Thank you.

    July 18, 2019 at 6:51 am Reply
    1. Ramsey Amin

      To be honest it sounds like you need to see a more skilled implant dentist. This is not common

      July 23, 2019 at 5:44 am Reply
      1. Chuck Coan

        Thank you for your honest opinion. I actually thought this establishment was the best skilled in the area. Is there a website that can show where to go for the “best skilled” in an area ?

        July 24, 2019 at 6:26 am Reply
      2. Chuck Coan

        Thank you for your honest opinion. I actually thought this establishment was the best skilled in the area. Is there a website that can show where to go for the “best skilled” in an area ?

        July 24, 2019 at 6:26 am Reply
  3. James Green

    Hi Dr. Amin,

    My lower first molar was extracted this week Monday (dentist said a deep cary on the root made the tooth unsalvageable). After the procedure, which was uncomplicated, the oral surgeon said that I had good bone there and that I would be fine for an implant in three months or so. He did not irrigate or scape the socket, left it as is, and did not mention anything about socket grafting, which was not done.

    Now I’m wondering if I should have asked to have some bone material put into the sockets post-extraction.

    Is it still possible to do socket grafting two weeks after the extraction?

    I am going to call the oral surgeon’s office on Monday but it would be great to have an opinion from you also if possible.

    I also wonder what the benefit in terms of % more bone versus natural healing would be, and what the risks of the procedure are and whether it’s worth going through the discomfort and being reset back to zero day healing again (as I imagine he would have to scrape the sockets before grafting?).

    I’m a 45 year old healthy male, in good shape generally though dentally I have suffered substantial gum recession and bone loss in the front teeth, stabilized the past few years with regular deep cleanings.

    Thanks for this great content.

    Jim

    November 17, 2018 at 5:56 am Reply
    1. Ramsey Amin

      YES –but just give it time if it is a molar. A bone graft can also be done at the time of implant placement.

      January 15, 2020 at 8:36 pm Reply
  4. Michael

    Hello,

    When lower tooth was extracted it was bone grafted and GTR and the gums along with the extraction area and adjacent tooth seemed to have risen and started reforming something to my pleasure. A week later it’s back to where it was before extraction. Does this mean anything?

    June 8, 2018 at 10:28 am Reply
    1. Ramsey Amin

      Possibly. Too early to tell

      January 15, 2020 at 8:35 pm Reply
  5. Nguyen

    Just want to write thanks so much for answering all of these questions from everywhere!!!
    You are a god send!

    May 7, 2018 at 1:56 am Reply
  6. K Shah

    Hello, I read your blog and impressed with information. I have question regarding my implant procedure going on. My extraction and bone grafting have been done in past Nov2015, now I have to go for implant but my doctor is saying that I am losing some bone but not giving proper explanation for that. Is that ok if I go through implant even though I am losing bone ? Need your advise on this.

    April 19, 2016 at 3:57 pm Reply
    1. RamseyAminDDS

      need more detail on what “loosing bone” means. If you’re just losing surface graft particles that is a completely different story than losing the main part of the bone graft which would support the implant both functionally and cosmetically.

      April 20, 2016 at 11:42 pm Reply
  7. Anonymous

    Hello Dr Ramsey Amin,

    I had an old short post that fractured the root under a crown so opted for an implant on ul5 which was small tooth so had to have the smallest thickness implant to ensure there was room between adjacent teeth to keep the papilla healthy. I am very happy with the appearance of the crown on the implant. My implant was placed over a year ago, 12 weeks after extraction apparently there was plenty of bone and my implant was placed.

    It has been very stable since and looks a great fit on the gum line – there are no black triangles. but I do wonder why there is a slight dint in the gum if I run my fingers over my gum, in comparison to feeling the roots of my adjacent teeth on the other parts of the gum, which pads the gum line out, when I had a socket preservation? I wondered is this normal – or is a socket preservation not meant to preserve where the roots stuck out as such if you have thin gums anyway? All my roots do literally stick out of my gums as I have thin gums. So you can see them and feel them very obviously.

    My dentist put in the powdered bone and a collagen plug and stitches after extraction. Apparently my extraction went seamlessly and the blood stopped quickly etc. I was asked to go back in after a few days and then weekly for monitoring for 8 weeks and everything was fine and three months later my implant went in.

    However on reflection I remember the collagen plug coming out after a day or two (which the dentist knew about as he spotted it). Now I wondered is that dent left in my gum/restructuring of the gum normal with an implant especially for someone who has thin gums with roots that are bulky through them? Or is this because that collagen plug came out, so could have been avoided?

    I have images of my mould so you can see the impression after the implant had been in a few months and where it looks sunken. Also a couple of pics of my gums with a normal picture taken today – I would like to post these however I cant seem to find a way to post them here?

    I would hugely appreciate your advice. Just to put my mind at rest either way :@)

    Thank you

    April 6, 2015 at 5:41 pm Reply
    1. Ramsey Amin DDS

      Yes. I saw your images. It looks like you had a well done procedure overall.

      You did lose a tiny bit of bone due to your thin bone gum bio type. The collagen plug likely had nothing to do with it. The type of bone that was used can prevent this in most cases.

      In thin bone situations, adding more cow bone to the human cadaver bone helps prevent collapse of the bone. It is too late for that, but fortunately you have a near perfect result.

      The root prominence can still be added if you wish. This is usually done with a gum graft. The graft can be cadaver or taken from your palate. It can then be slipped into the deficient area to bulk it up a bit. That tiny bit of bulk makes a big difference in a front tooth.

      You don’t have to do anything also. It is your choice.

      Good luck. Thanks for posting on my blog.
      😉

      Dr. Amin.

      April 7, 2015 at 3:21 am Reply
      1. Anonymous

        Thanks so much for responding and taking the time to look at my images. I really appreciate it :@)

        It’s put my mind at rest as I was worried if it was going to compromise the long term success of the implant having the slight depression from the other teeth by not having the root sticking out.

        It was a putty that was used so I may have got that wrong about it being cow bone but it’s good to know there is an option of gum graft should I ever need it. Sometimes I think when I’m talking it creates like an air bubble /squelch effect maybe against the action of my cheek talking against the depression, which can be distracting at times. However I may get used to this.

        I may post again somewhere else as I have an interesting and large apicoectomy procedure done 20 years ago in my teens after a sporting accident and I’m unsure whether to implant it now or wait to see how long it holds out. I’ve never had problems with it but I was told they don’t last for ever.

        Thanks so much for your help. You’re the best! :@)

        April 7, 2015 at 8:10 am Reply
    2. Preeti

      Hi I have pus on pre molar which is a baby tooth and doctor has told me that he has to extract the tooth and do the implant later. There is a small pimple on my gum and pus is keep cmg from last one month.
      I am scared please suggest what I should do?

      July 23, 2019 at 12:41 pm Reply
      1. Ramsey Amin

        Remove it. You will do great!! 😁

        July 30, 2019 at 5:21 am Reply

Write a Comment

Monica D.
Monica D.
December 29, 2020.
There aren't enough words (and I have a lot of words) to tell you how grateful I am to have found Dr. Ramsey Amin and his wonderful staff. I had an enormous amount of bone loss and I was hopeless after being treated by a different doctor for two years. I had multiple procedures such as gum graft, extractions, and a sinus lift. After all of that, the doctor released me and told me he could not help me any longer. He sent me to a large teaching hospital - who also had no idea how to help me. I was terrified and embarrassed. I had been missing teeth due to those procedures since 2017. That sent me out on a journey of meeting with no less than five different dentist/oral surgeons. Most of them shamed me for the bone loss and wondered what I had done to cause this. In reality, I had done nothing. The bone loss is my body's immune system fighting me, as well as hereditary traits. In fact not only was I having difficulty being able to have implants, I also had so much bone loss that I was also not a candidate for dentures. I researched "what to do when you have bone loss and can't get implants" and I found Dr. Amin's website. Then I researched him, read his reviews, watched every one of his You Tube videos. I called and got an appointment, and kept going to consultations with other providers. I had long since stopped smiling and being social. Missing teeth and the shaming was affecting my life so adversely. When I met with Dr. Amin for my consultation he was ready. He had all of my records and had already reviewed my scans. But more than that, he genuinely wanted to get to know about my life. He was/is authentic, kind and extremely professional with so much success and experience in difficult cases like mine. He worked up a treatment plan & I came back two weeks later to discuss my options...and the journey began. I have had three procedures under IV sedation, no pain, no narcotics needed for aftercare. Dr. Amin is a consumate, experienced oral surgeon who cares about your health & understands your fears. He communicates every step of the way and will provide you with all the information you need to make a decision to improve your health. I am still working toward my end goal, and we had to zig from traditional implants and zag to zygomatic implants instead...which is the reason I chose him in the first place. If there was nothing else that could be done to get me healthy & smiling again, I knew he would have that option to help me. And of course 2020, the year of CV-19. Don't worry, Dr. Amin & his staff follow all health & safety protocols. This review is long, because it is important you know my journey, so you might understand how fortunate I feel to be healing. I'm torn, because this place is like a great restaurant, I want to shout from the rooftops how great it is, how great he is. And at the same time, I want to keep this all to myself. I come 75 miles each way to see him. I know people travel from all over the world for his expertise. Do yourself a favor, have a consultation. You won't regret it. Dr. Amin is amazing and so is his staff.
Jennifer B.
Jennifer B.
December 18, 2020.
I cannot speak highly enough of Dr. Amin and his professional staff. I have to start off and say that I am absolutely TERRIFIED of the dentist due to several past experiences. I found myself putting this off for YEARS until I was referred over to Dr. Amin. I was petrified on my first visit... but he along with his WONDERFUL staff made me feel so calm and at ease. I had quite a bit of work that needed to be done, but we found the perfect plan that worked out for me, and I couldn't be happier. Words cannot express my gratitude to each and every staff member that made me feel safe and comfortable. Dr. Amin was always so attentive in asking if I was ever in pain... and I never was. These are truly remarkable individuals, and I'm so lucky to have a dentist that I can trust. I ABSOLUTELY LOVE each and every one of you! Thank you,
D M.
D M.
December 17, 2020.
I cannot say enough positive things about Dr. Amin and his staff. I originally found them on Yelp about two years ago. I needed an implant, front tooth of all places, and was extremely nervous not only about surgery but about how it would turn out. Let me just say I just adore the staff. Everyone is crazy friendly and the whole office has a very positive vibe. The staff is adorable and always has me smiling by the time I leave. They are all thorough and on-point about what they do, and I truly appreciate it. They are quick to respond to my emails no matter the question, and their appointment reminders are great too. Dr. Amin is very thorough and reassuring, and answered any questions my husband or I had. My regular dentist had questions about the procedure and Dr. Amin's office even reached out to them at my request (my dentist said they never received a call, but Dr. Amin's staff had date, time and notes - love the thoroughness!). After surgery the Dr. called to leave me a message about how it went. Very minimal pain during healing, never any pain during any visits. It took a few tries to get everything just right for the permanent crown (color, etc), but the end result is beyond fantastic! At one point during healing I thought I was experiencing some looseness or wiggling but unfortunately couldn't make it to the office. When I was finally able to make it in the Dr. was so relieved, bless his heart. Luckily it was just a false alarm and everything checked out ok. They're a bit further out from me, but I wanted the best. I sure found it! I wish they were my regular dentist, and I'm looking forward to seeing them again for my check-up which was delayed due to COVID.
Melissa E.
Melissa E.
December 9, 2020.
I found Dr. Amin a few years back after I hadn't been to a dentist in a decade. Many traumatic dental experiences in childhood have made me so phobic that even getting a cleaning was a knee-knocking, heart-pounding trial. But finally I couldn't put off some things any longer. During my first anesthesia session, Dr. Amin replaced five old metal fillings, and during the second he did three more plus a crown. I was completely comfortable, and never felt a thing. Because they were extra-long sessions, I did sleep for about 12 hours after, but the next day I felt just fine. This past week, my back top tooth cracked in half and fell out of my mouth, and a couple days later the crown on the remainder of the tooth fell out too! Despite being nervous about Covid 19, I had to get it taken care of, so I called and quizzed the staff about precautions, which turned out to be even above and beyond what I would have expected. So yesterday I went for the tooth extraction and plug. After they put on the blood pressure cuff and put in the IV, I gradually got a little tired and closed my eyes. I sat there for about 10 minutes and thought Gee, I wonder if they're going to get started any time soon, and a minute later Dr. Amin said "Wake up, you're all done!" That was a short session, and I didn't have the kind of fatigue I did my first time. I stayed up most of the evening. Today, everything is good! I'm taking my antibiotic and eating soft foods, and there is surprisingly little pain now that the numbness has worn off. The tooth site and my cheek are a little sore, and the corner of my mouth, and I have a very slight headache, but nothing to any great level--I'm not even taking the acetaminophen. I feel good, and wide awake. Thanks to everyone at the office for a comfortable and professional job! I really REALLY appreciate you for giving me painless dental experiences!
Tanya S.
Tanya S.
December 3, 2020.
What can I say about Dr. Amin he is the best! I'm so grateful for him. He has literally changed my life and given me the confidence to smile more. I had major restorative dental work done and everything went smoothly. Dr. Amin is very compassionate and he really cares about his patients he made me feel comfortable and cared for. He is very knowledgeable and has a great sense of humor. His office is very clean and they take the patients health and safety very serious. His staff is also amazing they made me feel very welcomed and important. I'm so happy I did my research and found Dr. Amin.  Thank you Dr. Amin and team.
Sheila S.
Sheila S.
November 6, 2020.
Two implants done! Finished all procedures and I couldn't be happier. It's the first time in years I looked forward to going to the dentist. Even during Covid life the staff and Dr. Amin took care of me. There is a possibility I may move to Long Beach but I would still travel to keep Dr. Amin as my dentist.
Allison S.
Allison S.
November 4, 2020.
I could not ask for a more caring, exceptionally knowledgeable dental care provider. He's not just a dentist, but someone who looks after your immediate dental needs and helps you plan and prepare for the future.
Julia R.
Julia R.
October 8, 2020.
I've been going to Dr. Amin since I turned 16 and have been going since. Before going to Dr. Amin's dental office, I had 4 crowns that I was not happy with and dealt with it until finally I asked Dr. Amin and because I  feel comfortable and because I trust him with his work I recently had my crowns fixed and worked on by  Dr. Amin and have never loved my smile the way I do now, I can actually enjoy my pictures, I can enjoy my smile from either angle and that really mattered to me. Thank you so much Dr. Amin still and will be in love with MY smile
Aaron D.
Aaron D.
October 6, 2020.
I've been coming to Dr. Ramsey for about five years and I have to say, he is by far the best dentist I've had - ever. The staff is professional and kind, the office is exceptionally well maintained, and Dr. Ramsey is careful and extremely knowledgeable about current developments and research in dentistry. I recently had a dental implant which was a long process but well worth it. I required a sinus lift as well as a bone graft. The surgery went off without a hitch, I was comfortable and the healing process was quick and without complication. Highly recommend!!
Flo O.
Flo O.
September 21, 2020.
This is my 1st review of Dr. Amin, and in my over 17 years of being with him, my experiences with Dr. Amin and his staff have always been positive.  I don't recall a bad experience with the several implant procedures i have had.  They run an efficient office.  I like that they are proactive and reach out to their patients to remind us of routine care needed.  Dr. Amin's bedside care is impeccable.  They are also technologically up to date in terms of sending out texts as reminders, ability to incorporate any appointment into your mobile phone.  That is certainly a plus.  Keep up the great care!!!