A tooth extraction involves removing a tooth from its socket in the bone. When a tooth is removed, the jawbone that supported it can begin to deteriorate because it no longer receives the stimulation from chewing. To help preserve this bone and prepare the site for future dental restorations, a bone graft is often included in the extraction procedure.
Understanding the Need for a Bone Graft
When a tooth is extracted, the empty socket undergoes bone resorption, where the jawbone shrinks in width and height due to lack of functional stimulation from the tooth’s root. Most of this bone loss happens within the first six to eighteen months following the extraction, with an estimated 50% of the alveolar bone width lost within the first year.
This reduction in bone volume can lead to complications, including changes in facial appearance, such as a sunken look, and shifting of adjacent teeth due to lack of support. A bone graft helps prevent this by filling the empty socket with bone grafting material, acting as a scaffold for new bone growth. Preserving the jawbone’s structure is important if dental implants are planned, as implants require sufficient healthy bone for stability and long-term success.
The Procedure: Step-by-Step Visuals
Local anesthesia is administered to numb the tooth and surrounding tissues. The dental team then prepares the area.
Once numb, the tooth is carefully removed from its socket, creating an empty space. The socket is then thoroughly cleaned to remove any debris or infected tissue.
Next, the bone graft material is placed directly into the empty socket. This material might be a granular or powdery substance, often white or off-white, resembling small irregular particles of sand or salt, or it may have a putty-like consistency. A protective barrier, often a collagen membrane, is then placed over the graft material. This membrane typically looks like a thin, white, or translucent sheet, similar to a piece of paper or cardboard, and helps to stabilize the graft while preventing soft tissue from growing into the bone space.
Finally, the gum tissue is repositioned and closed over the grafted site with sutures. These small threads, often black, blue, white, or clear, crisscross the incision site to hold the gum flaps in place and protect the newly placed graft.
What to Expect Immediately After
Immediately after the procedure, the extraction and graft site will show some visible changes. You will likely see the sutures. A small gauze pack might be placed over the area for you to bite on, helping to control any initial bleeding.
It is common to experience some swelling around the treated area, which might cause a noticeable puffiness on the cheek or jaw. Bruising can also develop, appearing as discoloration ranging from purple to yellowish hues on the skin. The site may appear discolored with sutures and minor bleeding. Initial numbness from the local anesthesia will gradually wear off, followed by mild discomfort.
To manage the immediate aftermath, you will be instructed to keep the gauze in place, typically for about 30 minutes, and to avoid disturbing the surgical site. Applying an ice pack to the outside of the cheek in 20-minute intervals can help reduce swelling. A soft diet is usually recommended initially to prevent pressure on the healing area.
The Healing Journey and Final Outcome
The healing process following a tooth extraction with a bone graft unfolds in stages. In the first few days to a week, the initial swelling and bruising will gradually subside. A blood clot forms in the socket, appearing as a dark red or brownish mass, which is crucial for healing and eventually transforms as new tissue begins to form.
During the subsequent weeks, typically from two to eight weeks, the sutures will either dissolve on their own or be removed by your dentist. The gum tissue covering the graft site will start to look less raw and more like normal, pink gum. Internally, the bone graft material begins to integrate, acting as a scaffold for the body’s natural bone cells to grow into and gradually replace the graft material. You might notice small, sand-like particles of the graft material coming out of the site during this phase, which is generally normal.
Over the longer term, from three to six months or even longer, the bone graft fully matures. During this period, the new bone forms and solidifies within the socket, creating a strong, dense foundation. Visually, the gum tissue will appear fully healed and seamless, blending with the surrounding gum. Internally, the jawbone will have regained much of its lost volume and density, preparing it for any subsequent restorative treatments, such as the placement of a dental implant.