Q: I’m just hard on things – especially my body. In the last five years, I’ve been paying the price in regards to my teeth. I’ve had to get a lot of crowns to save my teeth. Then about a year ago things got out of control on my upper right side and I had to have three teeth pulled: my upper right eye tooth and the two behind it. I can’t eat on that side and I can’t smile. I’m a bit upset that the dentist just pulled them. I didn’t ask enough questions when they were pulled and what came next. Since then I’ve gone back but the dentist doesn’t think I have enough bone for implants. I then saw someone else and he said that it was close. He did say I might need bone grafting before implants, so right now I’m deciding but I’m at a loss. How could the bone loss have been prevented? I now know that bone goes away after teeth are pulled but why wasn’t that said from the start? That’s what’s frustrating me – I seem to get the full story after it’s too late. I know it might not have been intended, but this doesn’t feel good. If there’s any light that can be shed-please!
A: Your story is a common one. Though preserving the bone after tooth extraction is a straightforward procedure it is not universally done. It’s not universally taught in dental schools until the specialty level so general dentists graduate without a clear philosophy and skill set to help their patients in this regard.
Another reason is that some dentists choose not to graft but to allow healing for six to eight weeks and then place implants.
While this is a viable technique if the extraction is uneventful and the socket is disease free and structurally intact it requires extremely good communication and follow up so that the opportunity and timing for placing implants is not missed. Bone begins to change shape and volume at about twelve weeks. If the socket walls are thin they may be lost in the reshaping of the socket that automatically takes place. This may lead to a boney ridge that is too thin to place implants. This reshaping of bone varies from person to person. After natural bone reshaping, some people may have enough bone width to place an implant while others do not.
I prefer to graft at extraction and have found at six months I have more than enough ridge width for implants.
As for your ridge, bone expansion techniques may be all that is needed to solve the ridge problem. Bone is “plastic” and can be expanded (albeit within certain limits). When done carefully it provides the necessary width for implants.