I had a consultation with a periodontist and I will be extracting the infected tooth soon. I have not been prescribed anything for the infection and he has not mentioned anything about the bone graft being done at a later date. I'm curious how other professionals proceed in this type of situation. I had a perforation that resulted in some bone loss and a pimple on my gums which I'm guessing is an infection. I will be getting an implant once it all heals.
Is Bone Grafting done immediately after the infected tooth is extracted?
Doctor Answers 7
Yes, ideally you want to have bone placed into the extraction socket at the same time as the extraction. This minimizes the number of surgical interventions and lowers the cost. As well, placing the bone graft at the time of extraction allows for better manipulation of the site to ensure a wider ridge that will hold the implant four months down the road.
We usually bone graft all of our extraction sockets at time of extraction. The use of the ND/YAG laser has changed the dynamics of the healing time frame and the quality of the bone. We use techniques that keeps the tissue instead of removing all the tissue as we were taught in dental school. This concept with the laser has changed the dynamics of surgery.
Every Situation is different. Every surgeon has their comfort zone as well. Infection in the extraction site is not a definitive contraindication for delayed bone graft. I routinely graft the socket of extracted teeth even if there is some infection present. The extraction site is prepared appropriately removing all infection until clean, the socket is then grafted using bone and an appropriate membrane if necessary. The 'Pimple" you describe could mean there is a "hole" in the bone in that region where pus was draining. this tissue needs to be removed and a membrane placed between the graft and surrounding tissue in order for it to heal. The time of extraction is the best bet to get a good grafting result, otherwise a much more significant graft will need to be done prior to implant placement. This is based on my experience only, but I have performed it several thousand times. I would NOT place an immediate implant in an infected site though. Grafts will heal as long as done correctly, but an implant will get infected about 50% of the time.In my office you most likely would have the graft done then delay the implant for 3-4 months
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Typically we wait 4 months or so for everything to clear up before placement of bone graft or implant. Good luck.
Generally the area is cleaned out and the graft is placed at the same visit. However the placement of an implant at the same visit is questionable based upon the severity of the infection and amount of bone loss.
It depends on a few things and the intent of the grafting procedure. If it is to maintain the width of bone from the extracted area for future implant placement, the area can be adequately cleaned and graft material placed. It is typical to wait longer before placing an implant in this situation however. If the intent is to create additional width of bone, usually the area should heal first. There are alot of different opinions on this subject, but if the periodontist you are seeing has experience in this area, defer to their judgement at the time of extraction.
If there is active infection the day of the extraction, then you will NOT be able to have grafting done the same day. I would imagine the periodontist or oral surgeon would want you to be on antibiotics at least 3 or 4 days prior to the extraction. Ask your surgeon these questions.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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