Do I need a bone graft if I have a tooth removed? The simple answer to that question is “probably”. For years and years teeth have been extracted with no thought to preserving the jawbone. Teeth are removed and some sort of dental prosthesis is fabricated such as a denture, a partial, or glued-in bridge. Those appliances are called on to replace the lost teeth as well as the bony support.
But there’s a problem with continued bone shrinkage over one’s lifetime. Bone shrinkage results in dentures that need lots of glue to keep them in and spaces under bridges where there did not used to be a space. Why is that?
What Happens When My Tooth Is Removed?
Our jawbones each have an extension of bone called the alveolus. The alveolus is the bone that supports teeth. If teeth are not present, neither is the alveolus. As babies we have jaw bones but no alveolus. Think of the gummy ridges babies have. They’re not very tall. As soon as teeth begin to form, so does the alveolus to support the teeth. You ever see a picture of an older person without teeth? It’s like they went back to the way they were as a baby. They have gummy ridges that aren’t that tall. What happened?
The body creates bone to support teeth. Remove a tooth and the body removes the alveolar bone because it’s no longer needed. Unless, of course, you want something to chew with! Those without teeth and dentures have a face that is sunken in and the distance between their nose and chin is shorter.
What If I Want Implants?
Dental implants are essentially titanium roots. In order to securely place an implant that’s long enough and wide enough to work, you need bone. You know, the alveolar bone. So, what happens if a tooth is lost an nothing’s done to preserve the alveolus. It shrinks down quickly during the first few months. That shrinkage happens both vertically and horizontally.
That means the jawbone gets shorter and thinner. Such a situation is often difficult to place the implant into and the restoration may not look as good as it could have. Sometimes the dentist can add bone after it’s been lost but that doubles the cost and requires an additional surgery. Who wants that?
As it turns out, we have a solution to the problem of bone shrinkage and loss after tooth extraction. The solution is socket grafting. Rather than removing a tooth and leaving it as is, you can have the socket filled in with bone graft material and that will preserve the bone! There will be a little shrinkage, but nearly all of the alveolus will remain the same size.
This is how it’s done. Immediately after a tooth is removed, the dentist fills in the socket with some type of graft material right up to the gumline. Many graft materials require that a barrier covers the graft so the skin cells (gum tissue), which grow faster than bone, don’t displace the graft. Think of the barrier as a type of Band-Aid. The body senses the presence of the graft and converts the graft into bone instead of resorbing it. Grafting a socket immediately after an extraction only adds a few minutes of procedural time. A side benefit is that you cannot get a dry socket. Why? Because it’s filled up with graft material!
This works for a good while, but if you want to maintain bone on the long term, you need a dental implant. The body seems to regard an implant as if it were a real tooth and keeps alveolar bone there to support it.
Socket graft material can be made out of various materials. Each has their own advantages. Here’s a short list:
- Bone from other animals
- Bone from other humans
- Your own bone
Don’t worry too much about where the graft material comes from. Purification processes are very strict and with the products I use, there has never been a case where some disease has been transferred from graft to patient.