Everyone Knows This

Question:

I’m the oldest of a family of four. All of us kids have health issues, so we watch out for one another. We’re close, but I’ve been out of the country, so when my sister said she was having all her teeth out, I said, “What!?” She said, “I’ve had bad teeth all my life and now I’ve got so much decay and abscessing, I have to get my teeth out.” I was aghast not knowing this about my sister. So, I said, “I’ll go with you. I want to be sure you’re doing the right thing.” “Well, what can you do,” she said. “I don’t know but I want to know more about this. I’ve got a friend who’s a dentist. I want to talk to him.” “Ok,” she said.

So, I talked to my dentist friend. He asked, “Is your sister having her sockets grafted after the teeth are removed?” “I don’t know,” I said. “Make sure that happens,” my dentist friend said, “because everyone knows that in the first year after a tooth is pulled, 50% of the bone dissolves so there may not be enough bone later on to put in implants.” So, I go with my sister and talk to the surgeon who’s removing my sister’s teeth. “Are you grafting the sockets,” I ask? “No,” says he, “but she’ll be fine.” “Really,” I say. “Yes.” “Ok, you’re the doctor.”

Four weeks later and my sister has no front teeth. I take her to my dentist friend. He takes 3D scans and shows me what’s left and tells me that after a year, she’ll have 50% of the bone volume she shows now. Why did the surgeon do that? How can everyone in the dental profession know the bone goes away and he cavalierly rips teeth out without grafting?

Answer:

Your question is a good one but many elements factor in. First is expense; grafting adds additional costs. Sometimes it’s not offered because it may delay needed treatment due to costs. Second, the procedure is technique sensitive and can be time consuming. Third, many surgeons like the gum to grow over the socket site before placing an implant. This technique works but timing is important. The patient needs to know that implant placement needs to occur (where grafting has not been placed) in eight to twelve weeks after extraction. Fourth, predictable grafting is about 30 years old. In other words, the right materials (bone, etc.), the right technique has been predictable for 30 years. I’ve seen it work in my hands since 1998. Having said that, it takes time for good things to take root (pun intended). In my view, if you remove teeth, your training and your delivery of those services should include bone grafting.

There are other reasons, of course, but a doctor must see the long view for the patient. If a patient says nothing is going in there (implant) for five years, that’s fine, but use the graft that will be there in five or ten years. Circumstances change. Attitudes change. Patients should be treated so that rehabilitation is always possible.

For you, your sister may be in that eight – twelve-week window where implant rehabilitation is possible. That will be your answer to help her out.