Dr. Crapo: Last week one of my molars that had been root canaled broke off at the gum line. My dentist told me the roots would have to come out and an implant placed. As luck would have it my dentist went on holidays two days later, just as my tongue was starting to go raw from rubbing against a sharp part of the broken tooth. I phoned and made an appointment with the dentist on call and when I told him what was going to happen he said “make sure to graft the socket and wait six months before placing the implant – that’ll give you the best results”. I said to him “I had been told that I make bone in abundance” and pointed out that I had lots of extra bone on the inside of my lower jaw. He told me the extra bone was called tori and didn’t necessarily have anything to do with the rate of bone I would grow after the tooth was extracted. He said the graft would be worth the money. I thought I could just have an implant put into the socket to replace the extracted root. If I can’t have that, can I just let the bone grow into the socket and then later when everything has healed, have the implant? I’m sure I grow bone fast because I have had these tori for as long as I can remember.
There are a number of issues here that should be addressed. Firstly, if your tooth broke off at the gum line but has not broken below the attachment line of the crown, you may be able to reuse the crown. If the root canal is in good shape, you may not need an implant at all.
The on call dentist was right – just because you have genetically formed tori, does not mean that your bone fills in any faster than someone else. Rates of growth can vary and some folks lose more bone after an extraction than others, but this too may depend on the amount of bone pre-extraction and how the extraction was handled by the surgeon. If the broken tooth is located between two teeth, you may get away by doing nothing and still have enough bone for an implant in 6 to 8 months. There is always a loss of bone without grafting, so be very cautious and have this assessed carefully. Grafting will also prevent impingement on a major nerve in the lower jaw and the sinus in the upper jaw and will prevent a more expensive and invasive graft in the future.
Placing an implant in the socket immediately after extraction works well with single rooted teeth but not as well with multi-rooted molars. Do the graft.
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