Bone Grafting in Dental Implants: Expert Opinions Compared

Regarding dental implant bone grafting?

Hello Doctor: The upper last molar cannot be saved due to decay, and after consulting with a doctor, I need to undergo dental implant surgery.
However, there are some discrepancies in the opinions of the two doctors regarding the implant procedure.
One doctor suggests that I should quickly extract the decayed tooth to prevent further bone loss (is this true?), and that after extraction, I should wait for the wound to heal before making a complete assessment to determine if bone grafting is necessary.
He assessed the X-ray and determined that sinus lift is not needed, but whether bone grafting is required will be evaluated after the extraction.
The other doctor recommends that a complete assessment should be done first before extracting the tooth (if bone grafting is necessary, it can be done simultaneously with the extraction).
This doctor believes that the bone height is insufficient based on the X-ray and that a sinus lift may be necessary.
Which doctor's approach is better? Is it advisable to extract the tooth first, or should a complete assessment be done before extraction? After extraction, will there be bone loss that would necessitate more bone grafting? P.S.
The decayed tooth does not hurt and has been decayed for almost a year.
Thank you for your response.

Niming, 30~39 year old female. Ask Date: 2016/03/23

Dr. Zeng Guanghui reply Dentistry

Due to cavities, tooth extraction followed by dental implant placement is necessary.
After extraction, whether to wait for the extraction site to heal for about 3-6 months before placing the implant depends on whether there are any lesions at the root apex of the extracted tooth and whether the original bone height and width are sufficient.
If the extracted tooth does not have any root apex lesions and the bone height and width are adequate, immediate implant placement after extraction can be considered.
However, if the bone height and width are not ideal, but it is assessed that initial stability can still be achieved after implant placement, simultaneous sinus lift and bone grafting can be performed during extraction, followed by implant placement.
If the bone height and width are significantly inadequate, it is recommended to first perform bone grafting and sinus lift after extraction, and then wait for 3-6 months for the bone foundation to heal before placing the implant.
Regardless of the approach taken, a comprehensive preoperative evaluation is essential, and it is best to obtain 3D cone beam computed tomography images to estimate the height and width of the alveolar ridge before discussing the treatment plan.

Reply Date: 2016/03/23

More Info

When considering dental implants, particularly in the context of bone grafting, it is essential to understand the implications of both the extraction of a tooth and the subsequent evaluation for bone grafting. Your situation involves two differing opinions from dental professionals regarding the timing of tooth extraction and the necessity of bone grafting, which is a common dilemma in dental care.

First, let's address the concern about the decayed tooth. It is true that if a tooth is severely decayed and cannot be restored, it may need to be extracted. The rationale behind the first dentist's advice to remove the tooth promptly is based on the idea that a decayed tooth can lead to further bone loss. When a tooth is compromised, the surrounding bone may begin to resorb (or diminish) due to the lack of stimulation that a healthy tooth provides. This process can indeed lead to a situation where there is insufficient bone for a future implant, necessitating bone grafting.

On the other hand, the second dentist's approach emphasizes a comprehensive evaluation before extraction. This method allows for a detailed assessment of the bone structure and the potential need for grafting. If the bone is found to be inadequate, performing a bone graft at the same time as the extraction can be beneficial. This simultaneous procedure can help preserve the bone and may lead to better outcomes for the implant.

Now, regarding your specific questions:
1. Is it better to extract the tooth first or to evaluate thoroughly before extraction?
The answer largely depends on the condition of the tooth and the surrounding bone. If the tooth is non-restorable and poses a risk of further bone loss, extraction may be warranted. However, if there is a possibility of preserving the tooth or if the evaluation suggests that bone grafting is necessary, a thorough assessment before extraction is advisable. This approach can help in planning the best course of action, potentially saving time and resources in the long run.

2. Will bone loss occur after extraction?
Yes, bone loss can occur after a tooth extraction. The alveolar bone, which supports the teeth, relies on the presence of teeth for stimulation. Once a tooth is removed, the bone may begin to resorb, leading to a decrease in bone volume and height. This is why timely intervention, such as bone grafting, is often recommended following an extraction, especially if an implant is planned.

3. Is bone grafting necessary?
The necessity for bone grafting depends on the amount of bone available after extraction. If the X-ray indicates that there is insufficient bone height or volume, grafting may be essential to provide a stable foundation for the implant. Bone grafting can help regenerate the bone and create a suitable environment for the implant.

In summary, both approaches have their merits. If the tooth is not causing pain and can be monitored, a thorough evaluation may be beneficial. However, if the tooth is at risk of causing further complications, timely extraction may be the best course of action. Consulting with a dental specialist who can provide a comprehensive evaluation and discuss the potential for bone grafting will help you make an informed decision. Ultimately, the goal is to ensure that you have a healthy foundation for your dental implant, which will lead to a successful and long-lasting restoration.

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