Why are graft particles coming out from my bone graft?

Question from Raj:   Why are graft particles coming out from my bone graft?  (details below)

I’m a 31 year old who just had my lower left impacted wisdom tooth extracted and as my dentist also suggested bone grafting to preserve bone structure, I went along with it. It’s now 10 days post surgery and I still find bits and pieces of the bone graft (not alot, maybe a couple of em a day) sometimes tend to appear in my mouth. I did speak to my oral surgeon who performed the surgery and he said it could be due to the membrane not covering the graft site fully. He says it’s OK and to just continue monitoring and let him know if there is a lot of them coming out.

My question would be is this normal following a bone graft ? What’s the point of me doing the bone graft if these bone particles continue to come out thereby defeating the purpose of trying to regenerate the bone loss due to the extraction ? Or is this really a minor matter ?
I’m going to have my stitches (he did the permanent stitches) removed tomorrow and would appreciate your opinion on this. To be honest I’m kind of regretting doing the bone graft now and would appreciate your insight.

Thank you.

Regards,
Raj

Answer:

Dear Raj:

Although people rarely get a bone graft for a third molar extraction, I do not criticize your surgeon for recommending it, as I have seen patients with a periodontal defect behind the second molar caused by bone loss after a third molar was extracted.

Now to answer your question.  In the case of an extraction socket graft for ridge preservation, it is common to see graft particles come out of the grafted area during the first few days, and it would depend on how well the collagen membrane or collagen plug seals the graft.  In cases where you tuck the membrane under the soft tissue borders it seals better than in cases where it just covers the hole.  After a couple of weeks, granulation tissue and epithelium start to cover the hole and cover the area, protecting the graft and allowing the bone in the socket walls to start growing tiny blood vessels through the graft to start the process of turning the bone graft particles into your own bone.

As long as most of the bone graft particles have remained in the socket and are covered by gum tissue to seal the wound, you should be fine.  When your surgeon removes the sutures, he will examine the area and he will be able to tell you if everything is healing well.

Good luck !

Dentist In West Palm Beach
Carlos Boudet, DDS
1840 Forest Hill Blvd, Suite 204
West Palm Beach, Florida  33406
Phone: Call 561-968-6022

Website: http://www.boudetdds.com
Blog;  http://mywestpalmbeachdentist.blogspot.com

 

Thanks for sharing

About Carlos Boudet, DDS, DICOI

Dr. Boudet is a graduate of the Medical College of Virginia. After graduating with a DDS degree in 1980, he became a commissioned officer for the United States Public Health Service. When his tour of duty ended in 1982 he received an award for outstanding service. He was asked to serve as Dental Director for Florida Community Heath Centers, supervise the operation of four dental clinics around lake Okeechobee. He established his dental practice in West Palm Beach in 1983 and has been in the same location for 30 years. He is a Diplomate of the International Congress of Oral Implantologists, a member of the Central Palm Beach County Dental Society and a chairman of the Advanced Crown and Bridge course of the Atlantic Coast Dental Research Clinic. His articles on prosthodontics and implants have been published in several popular dental magazines.

4 Comments

  1. I had a rear lower molar extracted fifteen days ago followed by granular bone grafting. The dentist said stitches would come out on their own, which they did. for the past six days everything felt fine and there looked to be white hard shapes in the socket that I assumed were the hardened material from the grafts. I have had no pain, bleeding or any signs of redness or irritation. After breakfast this morning when I went to brush my teeth, I noticed the white pieces were gone. There isn’t any pain or redness. but there just seems to be a hole where the white pieces were. It is a holiday weekend and I am scheduled for my followup on Tuesday. Is this the normal healing process? Should I avoid eating any solid foods until Tuesday?

    • Dear Gary:
      Without examining you as a patient, I cannot tell you if you are healing normally.
      There is nothing you can do other than avoid eating on that area.
      Just call the dentist’s office and explain your concern. They are the ones that need to tell you what to do and maybe look at the graft area.
      Thanks for your question and good luck!

  2. Dear Dr. Carlos Boudet, I am from Myanmar and I did Implant place with the bone graft (lateral window sinus lift) at the upper left first molar region 3 months ago. But, from last 3 weeks, patient told me that there is a localized swelling at the buccal side of grafted area with pain and sometimes graft white particles are coming out.

    Could you please kindly give me your expert opinion how to deal with this complication?
    Sincerely,
    Zayar Lin

    • Dear Dr. Lin
      There are many things to consider here and you do not provide much information.
      What happened during the first month?
      Has the patient been seen?
      Is the surgical site opened or a fistula present?
      Maybe you should have done the graft first and wait for implant placement.
      You should evaluate the patient and cover with an antibiotic like Augmentin.
      Refer the case to an experienced oral surgeon and observe how he treats the complication.
      Remember that you need to learn not only how to do a procedure, but also how to treat any complications that may develop.
      Go back and re-examine everything you did and try to determine what you did wrong.
      You can learn more from your mistakes than from successful cases.
      Good luck!

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