OT: Bone graft after extraction

[kev374]

thanks doc, spot on, tooth #16 that’s what it says on my estimate.

there is also an estimate to remove 3 amalgam fillings and replace them with composite fillings. He says amalgam fillings don’t bond well with the tooth surface and can start leaking causing decay under it. Since the current fillings are in good shape and have no decay I will have to pay for the replacement. Wondering if it is necessary.

This is an excerpt from the dentist’s website:

Dr. xxxx and his team performs most wisdom teeth extractions under an advanced technique that has been advocated by many surgeons all over the world. The method of bone augmentation accompanied with the extraction and implant therapy. In a world of osteoporosis and bone loss in the jaw being a leading factor leading to tooth loss.

Dr. xxxx has developed a sound technique for bone in the jaw to be preserved especially after an extraction. Extractions done with these various types of grafting material has now been able to maintain your natural healthy bone. With the grafting incorporated with the extractions, we at xxxxx have eliminated the painful side effect from the traditional extractions called DRY SOCKET.

‘Dry Socket’ is the loss of bone by untreated extraction sites, which is usually two-thirds of the jawbone’s original height. Adjacent teeth can also be affected due to the loss of supporting bone. This situation can result in a receding jawline, causing loose and shifting teeth, gum pockets, difficulty in chewing, bite collapse, unattractive facial lines and a general appearance of aging.

[Anonymous]

“Dr. xxxx has developed a sound technique for bone in the jaw to be preserved especially after an extraction. Extractions done with these various types of grafting material has now been able to maintain your natural healthy bone. With the grafting incorporated with the extractions, we at xxxxx have eliminated the painful side effect from the traditional extractions called DRY SOCKET.”

I might, and I say “might”, meaning less than 1% of the time, use a bone graft on LOWER 3rd molar extractions when teeth have been impacted and need to be cut out. Again, yours is upper left so the quote above does not apply in your case. Your body regenerates bone naturally. No need (in the case of #16) to bone graft. If it were in the front or maybe any tooth not a 3rd molar then I would say think about it. Your bone will fill it in naturally. I know Oral Surgeons who do not use bone grafts for 3rd molars.

Amalgam fillings are another story. If silver fillings are more than 15-20 years old I usually recommend replacing them. Great material, last a long time, but they are metal (silver, copper, mercury contents), which expands and contracts over time when fluids, whether hot or cold (water, coffee, juice etc) interact w/the filling. This expansion and contraction is microscopic. Over a period of years it can and does leak. It’s extremely hard to tell if the filling is leaking and has a cavity underneath it until it is too late and you need a root canal. Silver fillings are not bonded to the tooth. Composite or tooth colored fillings are bonded chemically, but they too have to be replaced. Remember this stuff is man made. You have to change the oil in your car right? Also if the silver fillings take up more than two/thirds of the chewing surface of your tooth, I usually recommend a crown. The large silver fillings tend to act as a wedge in your tooth and can split them. Imagine a metal wedge in a tree and you using a hammer to hammer it in…it splits the tree. Thats why large fillings turn into cracked teeth.

Recap: 1) is the filling more than 15 – 20 years old. 2) Is the filling large. 3) Are you unhappy w/the look and feel of the metal?. 4) Will insurance pay for the replacement. If you answered yes to these, then replace them. If these are a no, then just tell your dentist you would like to just watch and wait for signs or symptoms of a cavity/recurrent decay. In other words, I trust your dentist’s judgement, but if you just got these fillings done 5 years ago, I’d get some more milage out of the ones you have. If it’s cracked or poor margins where the filling meets the tooth, definitely replace it.

Dr. RD

[Anonymous]

“Dr. xxxx has developed a sound technique for bone in the jaw to be preserved especially after an extraction. Extractions done with these various types of grafting material has now been able to maintain your natural healthy bone. With the grafting incorporated with the extractions, we at xxxxx have eliminated the painful side effect from the traditional extractions called DRY SOCKET.”

I might, and I say “might”, meaning less than 1% of the time, use a bone graft on LOWER 3rd molar extractions when teeth have been impacted and need to be cut out. Again, yours is upper left so the quote above does not apply in your case. Your body regenerates bone naturally. No need (in the case of #16) to bone graft. If it were in the front or maybe any tooth not a 3rd molar then I would say think about it. Your bone will fill it in naturally. I know Oral Surgeons who do not use bone grafts for 3rd molars.

Amalgam fillings are another story. If silver fillings are more than 15-20 years old I usually recommend replacing them. Great material, last a long time, but they are metal (silver, copper, mercury contents), which expands and contracts over time when fluids, whether hot or cold (water, coffee, juice etc) interact w/the filling. This expansion and contraction is microscopic. Over a period of years it can and does leak. It’s extremely hard to tell if the filling is leaking and has a cavity underneath it until it is too late and you need a root canal. Silver fillings are not bonded to the tooth. Composite or tooth colored fillings are bonded chemically, but they too have to be replaced. Remember this stuff is man made. You have to change the oil in your car right? Also if the silver fillings take up more than two/thirds of the chewing surface of your tooth, I usually recommend a crown. The large silver fillings tend to act as a wedge in your tooth and can split them. Imagine a metal wedge in a tree and you using a hammer to hammer it in…it splits the tree. Thats why large fillings turn into cracked teeth.

Recap: 1) is the filling more than 15 – 20 years old. 2) Is the filling large. 3) Are you unhappy w/the look and feel of the metal?. 4) Will insurance pay for the replacement. If you answered yes to these, then replace them. If these are a no, then just tell your dentist you would like to just watch and wait for signs or symptoms of a cavity/recurrent decay. In other words, I trust your dentist’s judgement, but if you just got these fillings done 5 years ago, I’d get some more milage out of the ones you have. If it’s cracked or poor margins where the filling meets the tooth, definitely replace it.

Dr. RD

[Anonymous]

“Dr. xxxx has developed a sound technique for bone in the jaw to be preserved especially after an extraction. Extractions done with these various types of grafting material has now been able to maintain your natural healthy bone. With the grafting incorporated with the extractions, we at xxxxx have eliminated the painful side effect from the traditional extractions called DRY SOCKET.”

I might, and I say “might”, meaning less than 1% of the time, use a bone graft on LOWER 3rd molar extractions when teeth have been impacted and need to be cut out. Again, yours is upper left so the quote above does not apply in your case. Your body regenerates bone naturally. No need (in the case of #16) to bone graft. If it were in the front or maybe any tooth not a 3rd molar then I would say think about it. Your bone will fill it in naturally. I know Oral Surgeons who do not use bone grafts for 3rd molars.

Amalgam fillings are another story. If silver fillings are more than 15-20 years old I usually recommend replacing them. Great material, last a long time, but they are metal (silver, copper, mercury contents), which expands and contracts over time when fluids, whether hot or cold (water, coffee, juice etc) interact w/the filling. This expansion and contraction is microscopic. Over a period of years it can and does leak. It’s extremely hard to tell if the filling is leaking and has a cavity underneath it until it is too late and you need a root canal. Silver fillings are not bonded to the tooth. Composite or tooth colored fillings are bonded chemically, but they too have to be replaced. Remember this stuff is man made. You have to change the oil in your car right? Also if the silver fillings take up more than two/thirds of the chewing surface of your tooth, I usually recommend a crown. The large silver fillings tend to act as a wedge in your tooth and can split them. Imagine a metal wedge in a tree and you using a hammer to hammer it in…it splits the tree. Thats why large fillings turn into cracked teeth.

Recap: 1) is the filling more than 15 – 20 years old. 2) Is the filling large. 3) Are you unhappy w/the look and feel of the metal?. 4) Will insurance pay for the replacement. If you answered yes to these, then replace them. If these are a no, then just tell your dentist you would like to just watch and wait for signs or symptoms of a cavity/recurrent decay. In other words, I trust your dentist’s judgement, but if you just got these fillings done 5 years ago, I’d get some more milage out of the ones you have. If it’s cracked or poor margins where the filling meets the tooth, definitely replace it.

Dr. RD

[Anonymous]

“Dr. xxxx has developed a sound technique for bone in the jaw to be preserved especially after an extraction. Extractions done with these various types of grafting material has now been able to maintain your natural healthy bone. With the grafting incorporated with the extractions, we at xxxxx have eliminated the painful side effect from the traditional extractions called DRY SOCKET.”

I might, and I say “might”, meaning less than 1% of the time, use a bone graft on LOWER 3rd molar extractions when teeth have been impacted and need to be cut out. Again, yours is upper left so the quote above does not apply in your case. Your body regenerates bone naturally. No need (in the case of #16) to bone graft. If it were in the front or maybe any tooth not a 3rd molar then I would say think about it. Your bone will fill it in naturally. I know Oral Surgeons who do not use bone grafts for 3rd molars.

Amalgam fillings are another story. If silver fillings are more than 15-20 years old I usually recommend replacing them. Great material, last a long time, but they are metal (silver, copper, mercury contents), which expands and contracts over time when fluids, whether hot or cold (water, coffee, juice etc) interact w/the filling. This expansion and contraction is microscopic. Over a period of years it can and does leak. It’s extremely hard to tell if the filling is leaking and has a cavity underneath it until it is too late and you need a root canal. Silver fillings are not bonded to the tooth. Composite or tooth colored fillings are bonded chemically, but they too have to be replaced. Remember this stuff is man made. You have to change the oil in your car right? Also if the silver fillings take up more than two/thirds of the chewing surface of your tooth, I usually recommend a crown. The large silver fillings tend to act as a wedge in your tooth and can split them. Imagine a metal wedge in a tree and you using a hammer to hammer it in…it splits the tree. Thats why large fillings turn into cracked teeth.

Recap: 1) is the filling more than 15 – 20 years old. 2) Is the filling large. 3) Are you unhappy w/the look and feel of the metal?. 4) Will insurance pay for the replacement. If you answered yes to these, then replace them. If these are a no, then just tell your dentist you would like to just watch and wait for signs or symptoms of a cavity/recurrent decay. In other words, I trust your dentist’s judgement, but if you just got these fillings done 5 years ago, I’d get some more milage out of the ones you have. If it’s cracked or poor margins where the filling meets the tooth, definitely replace it.

Dr. RD

[Anonymous]

“Dr. xxxx has developed a sound technique for bone in the jaw to be preserved especially after an extraction. Extractions done with these various types of grafting material has now been able to maintain your natural healthy bone. With the grafting incorporated with the extractions, we at xxxxx have eliminated the painful side effect from the traditional extractions called DRY SOCKET.”

I might, and I say “might”, meaning less than 1% of the time, use a bone graft on LOWER 3rd molar extractions when teeth have been impacted and need to be cut out. Again, yours is upper left so the quote above does not apply in your case. Your body regenerates bone naturally. No need (in the case of #16) to bone graft. If it were in the front or maybe any tooth not a 3rd molar then I would say think about it. Your bone will fill it in naturally. I know Oral Surgeons who do not use bone grafts for 3rd molars.

Amalgam fillings are another story. If silver fillings are more than 15-20 years old I usually recommend replacing them. Great material, last a long time, but they are metal (silver, copper, mercury contents), which expands and contracts over time when fluids, whether hot or cold (water, coffee, juice etc) interact w/the filling. This expansion and contraction is microscopic. Over a period of years it can and does leak. It’s extremely hard to tell if the filling is leaking and has a cavity underneath it until it is too late and you need a root canal. Silver fillings are not bonded to the tooth. Composite or tooth colored fillings are bonded chemically, but they too have to be replaced. Remember this stuff is man made. You have to change the oil in your car right? Also if the silver fillings take up more than two/thirds of the chewing surface of your tooth, I usually recommend a crown. The large silver fillings tend to act as a wedge in your tooth and can split them. Imagine a metal wedge in a tree and you using a hammer to hammer it in…it splits the tree. Thats why large fillings turn into cracked teeth.

Recap: 1) is the filling more than 15 – 20 years old. 2) Is the filling large. 3) Are you unhappy w/the look and feel of the metal?. 4) Will insurance pay for the replacement. If you answered yes to these, then replace them. If these are a no, then just tell your dentist you would like to just watch and wait for signs or symptoms of a cavity/recurrent decay. In other words, I trust your dentist’s judgement, but if you just got these fillings done 5 years ago, I’d get some more milage out of the ones you have. If it’s cracked or poor margins where the filling meets the tooth, definitely replace it.

Dr. RD

[Ricechex]

Dr RD,
I have some questions too! I am fairly obsessed about my mouth and teeth.

I have been seeing a perio for many years due to gum problems. Been through the surgery in my late 30’s and so far so good. I get my teeth cleaned every 90 days, rain or shine, by the dental hygenist at the perio’s office.

I had a dentist put some type of matching stuff on my 2 front teeth where there were grooves, that was over 5 years ago, and now there are indentations. Can those be replaced? Are they just matching fillings? (there was no decay)

Also, what is your opinion on the one hour whitening? Has it improved? I did it 7 years ago and my teeth didn’t stay white for very long–a few months. I drink a lot of ice tea. (I did give up the red wine for awhile).

[Ricechex]

Dr RD,
I have some questions too! I am fairly obsessed about my mouth and teeth.

I have been seeing a perio for many years due to gum problems. Been through the surgery in my late 30’s and so far so good. I get my teeth cleaned every 90 days, rain or shine, by the dental hygenist at the perio’s office.

I had a dentist put some type of matching stuff on my 2 front teeth where there were grooves, that was over 5 years ago, and now there are indentations. Can those be replaced? Are they just matching fillings? (there was no decay)

Also, what is your opinion on the one hour whitening? Has it improved? I did it 7 years ago and my teeth didn’t stay white for very long–a few months. I drink a lot of ice tea. (I did give up the red wine for awhile).

[Ricechex]

Dr RD,
I have some questions too! I am fairly obsessed about my mouth and teeth.

I have been seeing a perio for many years due to gum problems. Been through the surgery in my late 30’s and so far so good. I get my teeth cleaned every 90 days, rain or shine, by the dental hygenist at the perio’s office.

I had a dentist put some type of matching stuff on my 2 front teeth where there were grooves, that was over 5 years ago, and now there are indentations. Can those be replaced? Are they just matching fillings? (there was no decay)

Also, what is your opinion on the one hour whitening? Has it improved? I did it 7 years ago and my teeth didn’t stay white for very long–a few months. I drink a lot of ice tea. (I did give up the red wine for awhile).

[Ricechex]

Dr RD,
I have some questions too! I am fairly obsessed about my mouth and teeth.

I have been seeing a perio for many years due to gum problems. Been through the surgery in my late 30’s and so far so good. I get my teeth cleaned every 90 days, rain or shine, by the dental hygenist at the perio’s office.

I had a dentist put some type of matching stuff on my 2 front teeth where there were grooves, that was over 5 years ago, and now there are indentations. Can those be replaced? Are they just matching fillings? (there was no decay)

Also, what is your opinion on the one hour whitening? Has it improved? I did it 7 years ago and my teeth didn’t stay white for very long–a few months. I drink a lot of ice tea. (I did give up the red wine for awhile).

[Ricechex]

Dr RD,
I have some questions too! I am fairly obsessed about my mouth and teeth.

I have been seeing a perio for many years due to gum problems. Been through the surgery in my late 30’s and so far so good. I get my teeth cleaned every 90 days, rain or shine, by the dental hygenist at the perio’s office.

I had a dentist put some type of matching stuff on my 2 front teeth where there were grooves, that was over 5 years ago, and now there are indentations. Can those be replaced? Are they just matching fillings? (there was no decay)

Also, what is your opinion on the one hour whitening? Has it improved? I did it 7 years ago and my teeth didn’t stay white for very long–a few months. I drink a lot of ice tea. (I did give up the red wine for awhile).

[Anonymous]

Great questions!

Ricechex,

Good to hear you are going in for your regular perio maintenance visits. Once diagnosed w/periodontal disease, this is lifelong. It’s episodic/periodic and it can have a mind of it’s own at times. It’s exacerbated by smoking, poor oral hygiene, underlying systemic disease, many others not mentioned and also genetics. Bone loss around your teeth is no joke. Stay on top of your flossing/brushing at least 2 day and definately the regular visits.

The matching stuff you are talking about sounds like you are describing tooth colored fillings as well, but used for cosmetic purposes to close gaps in front teeth or even discoloration or grooves as you say. If you noticed the filling is wearing down, indentations or any material missing, it may have broken/chipped away. Yes, from what you are describing it can be replaced. If it is a composite (tooth colored) filling (which that’s what it sounds like), it shouldn’t be a problem to match your existing tooth color and rebond or redo the filling to fill in the pot holes if you will.

One hour whitening is great stuff, but it does not last forever. If you get some whitening trays from your dentist w/take home bleach, it will help maintain the “whiteness” shade you achieved w/the in office bleach. Basically whitening comes in strengths of active ingredient (carbamide peroxide) in the bleach used. Over the counter around 5% or less. Take home bleach goes from 10%-20% and 1 hour whitening uses 25% – 40% active ingredient. The higher the concentration, the whiter the teeth get but you will get increased sensitivity too for a couple of days after use. The problem w/over the counter bleach is the percentage is too low to notice a “pop” or “bling” whiteness to your teeth. Whitening toothpaste also does not stay on your teeth long enough to really do much good. Yes, i’m an advocate of In Office Bleaching, but knowing it won’t last forever depending on your diet. Minimize red whine, coffee, tea, or dark colored beverages. Also, if you can’t drop the tea habit, use a straw every time you drink these. It will help tremendously.

Dr. RD

[Anonymous]

Great questions!

Ricechex,

Good to hear you are going in for your regular perio maintenance visits. Once diagnosed w/periodontal disease, this is lifelong. It’s episodic/periodic and it can have a mind of it’s own at times. It’s exacerbated by smoking, poor oral hygiene, underlying systemic disease, many others not mentioned and also genetics. Bone loss around your teeth is no joke. Stay on top of your flossing/brushing at least 2 day and definately the regular visits.

The matching stuff you are talking about sounds like you are describing tooth colored fillings as well, but used for cosmetic purposes to close gaps in front teeth or even discoloration or grooves as you say. If you noticed the filling is wearing down, indentations or any material missing, it may have broken/chipped away. Yes, from what you are describing it can be replaced. If it is a composite (tooth colored) filling (which that’s what it sounds like), it shouldn’t be a problem to match your existing tooth color and rebond or redo the filling to fill in the pot holes if you will.

One hour whitening is great stuff, but it does not last forever. If you get some whitening trays from your dentist w/take home bleach, it will help maintain the “whiteness” shade you achieved w/the in office bleach. Basically whitening comes in strengths of active ingredient (carbamide peroxide) in the bleach used. Over the counter around 5% or less. Take home bleach goes from 10%-20% and 1 hour whitening uses 25% – 40% active ingredient. The higher the concentration, the whiter the teeth get but you will get increased sensitivity too for a couple of days after use. The problem w/over the counter bleach is the percentage is too low to notice a “pop” or “bling” whiteness to your teeth. Whitening toothpaste also does not stay on your teeth long enough to really do much good. Yes, i’m an advocate of In Office Bleaching, but knowing it won’t last forever depending on your diet. Minimize red whine, coffee, tea, or dark colored beverages. Also, if you can’t drop the tea habit, use a straw every time you drink these. It will help tremendously.

Dr. RD

[Anonymous]

Great questions!

Ricechex,

Good to hear you are going in for your regular perio maintenance visits. Once diagnosed w/periodontal disease, this is lifelong. It’s episodic/periodic and it can have a mind of it’s own at times. It’s exacerbated by smoking, poor oral hygiene, underlying systemic disease, many others not mentioned and also genetics. Bone loss around your teeth is no joke. Stay on top of your flossing/brushing at least 2 day and definately the regular visits.

The matching stuff you are talking about sounds like you are describing tooth colored fillings as well, but used for cosmetic purposes to close gaps in front teeth or even discoloration or grooves as you say. If you noticed the filling is wearing down, indentations or any material missing, it may have broken/chipped away. Yes, from what you are describing it can be replaced. If it is a composite (tooth colored) filling (which that’s what it sounds like), it shouldn’t be a problem to match your existing tooth color and rebond or redo the filling to fill in the pot holes if you will.

One hour whitening is great stuff, but it does not last forever. If you get some whitening trays from your dentist w/take home bleach, it will help maintain the “whiteness” shade you achieved w/the in office bleach. Basically whitening comes in strengths of active ingredient (carbamide peroxide) in the bleach used. Over the counter around 5% or less. Take home bleach goes from 10%-20% and 1 hour whitening uses 25% – 40% active ingredient. The higher the concentration, the whiter the teeth get but you will get increased sensitivity too for a couple of days after use. The problem w/over the counter bleach is the percentage is too low to notice a “pop” or “bling” whiteness to your teeth. Whitening toothpaste also does not stay on your teeth long enough to really do much good. Yes, i’m an advocate of In Office Bleaching, but knowing it won’t last forever depending on your diet. Minimize red whine, coffee, tea, or dark colored beverages. Also, if you can’t drop the tea habit, use a straw every time you drink these. It will help tremendously.

Dr. RD

[Anonymous]

Great questions!

Ricechex,

Good to hear you are going in for your regular perio maintenance visits. Once diagnosed w/periodontal disease, this is lifelong. It’s episodic/periodic and it can have a mind of it’s own at times. It’s exacerbated by smoking, poor oral hygiene, underlying systemic disease, many others not mentioned and also genetics. Bone loss around your teeth is no joke. Stay on top of your flossing/brushing at least 2 day and definately the regular visits.

The matching stuff you are talking about sounds like you are describing tooth colored fillings as well, but used for cosmetic purposes to close gaps in front teeth or even discoloration or grooves as you say. If you noticed the filling is wearing down, indentations or any material missing, it may have broken/chipped away. Yes, from what you are describing it can be replaced. If it is a composite (tooth colored) filling (which that’s what it sounds like), it shouldn’t be a problem to match your existing tooth color and rebond or redo the filling to fill in the pot holes if you will.

One hour whitening is great stuff, but it does not last forever. If you get some whitening trays from your dentist w/take home bleach, it will help maintain the “whiteness” shade you achieved w/the in office bleach. Basically whitening comes in strengths of active ingredient (carbamide peroxide) in the bleach used. Over the counter around 5% or less. Take home bleach goes from 10%-20% and 1 hour whitening uses 25% – 40% active ingredient. The higher the concentration, the whiter the teeth get but you will get increased sensitivity too for a couple of days after use. The problem w/over the counter bleach is the percentage is too low to notice a “pop” or “bling” whiteness to your teeth. Whitening toothpaste also does not stay on your teeth long enough to really do much good. Yes, i’m an advocate of In Office Bleaching, but knowing it won’t last forever depending on your diet. Minimize red whine, coffee, tea, or dark colored beverages. Also, if you can’t drop the tea habit, use a straw every time you drink these. It will help tremendously.

Dr. RD

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