Do I need a bone graft after an extraction?


Why do I need a bone graft in the area of the tooth that needs to be extracted?


There are cases where a bone graft is not very necessary, and instances where doing a bone graft after an extraction is very important. Here are some examples:
When you extract a wisdom tooth or a second molar and you don’t have plans to replace the extracted tooth with an implant, there is no reason to do a bone graft.
If however, you are having
1- A front tooth removed
2- Are planning to put an implant several months after healing occurs
3- Have lost bone because of trauma or infection
4- Or have just enough bone to place an implant but cannot afford to loose any more.

Then it is very important that you graft the extraction site at the time the tooth is removed.
Without a graft, the bone around the extracted tooth immediately starts to remodel and shrink.  This may leave the area with not enough bone to place an implant, or with deficient gum tissue that would look unatractive in an esthetic area.
In any of the four examples mentioned above, loosing bone due to the normal remodeling that happens after an extraction, can make the difference between an excellent outcome or results that are less than adequate and more prone to complications if you have to place an implant where there is inadequate bone height or width.

There are more reasons why a bone graft after an extraction is recommended.
The graft does increase the total cost of the procedure, but when indicated, it is well worth it.

Carlos Boudet, DDS, DICOI
1840 Forest Hill Blvd, Suite 204
West Palm Beach, Florida
Phone: (561) 968 6022


By submitting your question you agree that the information provided on this website is for educational  purposes only. It is not to be considered as offering professional advice.  We are not liable for any damages resulting from your use of the information on our web site, and said information should not be used as a substitute for the advice of a  qualified and licensed dentist or other health care provider.

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.


  1. Hello, i had a root canal on molar 18 and pain continued. The root canal was done because of pain on the tooth X-ray never showed an infection or crack. The endo who originally performed the root canal doesn’t want to retreat, she says she did it perfect and that xrays don’t show anything wrong. She also said she didn’t see a crack. I went for a second opinion an they think my tooth has a crack because when I bite down it hurts towards the back of the tooth on a certain spot. Their first approach is to retreat Incase a canal was missed. But I would just like to extract it. Would I need a bone craft. I plan to get an implant but in a couple of yrs. Also can braces close the gap. I planned to get braces.

    • Hello Jasmin,
      I am not sure what your question is.
      If a canal was missed, it will be seen in a CBCT of the tooth.
      Most endodontists have a CBCT machine in their office today and can tell if a canal was missed without having to reopen the tooth.
      If you are going to wait a couple of years for the implant, you should get a bone graft because you will definitely lose bone after the extraction.
      In my experience, a molar leaves a space that is too large to close with braces.
      Good luck!

  2. Charlotte Wagner

    Dear Dr. Boudet
    I had a failed root canal on my top second molar.#2 I find out now it is a cracked root and needs to be extracted. The dentist wants to do a bone graft but after reading your blog I understand that if I do not plan on a having an implant I do not need the bone graft unless there would be a concern for a peridontal pocket that would develop in the tooth next to it. How would that be determined before I have the extraction and make a final decision. What also is the synthethic material that is used ? Am I understanding this correctly. Thank You for educating us all there is so much information CharlotteCorona CA

    • Dear Charlotte:
      I am sorry that you will have to extract your molar, and thank you for expressing your gratitude for the material in my blog. I agree that there is a lot of information to consider.
      Regarding the synthetic graft material used, there are about a dozen different ones, and the dentist chooses his or her preference.
      If you do not plan to get an implant to replace the extracted second molar now or in the future, I see no need for a bone graft, but please ask all these questions to the dentist that is doing your treatment, since he or she is the most appropriate individual to get professional advise from, and I cannot give you advise through a blog.
      Good luck and thank you for your comment.

  3. I am 23 and need an extraction on tooth 14 … im debating the the need for a bone graft and implant i still have all my wisdom teeth so im aware although it would be somewhat painful the teeth would move on their own to some degree, would this be enough or would the graft a implant be necessary

    • Hello Jessie,
      The molars will never close the space left by the extraction of tooth #14 on their own. Even with orthodontics and TADS (temporary implants to keep the other teeth from moving back) it may be difficult to close the space.
      Ideally, grafting the extraction socket and placing an implant later is the solution.
      Alternatively, you can refuse the graft and implant and allow the teeth to drift on their own. The bite will be affected, but you will still be able to function.
      the decision is yours.
      Good luck!

  4. Hi Doctor,

    I need your advice, my second molar on bottom right had RCT done 2 years back, last year my crown came out and now my RCT got and infection and I am feeling pain. Doctor advised me for extraction, bone graft and implant. But I am not considering implant and going for extraction, but not sure of bone graft. So, please suggest should I go for bone graft or not, are there any disadvantages like infection, others, etc with only bone graft in future(no plan for implant in future). I am 31 years old.


    • Arpit,
      I can’t suggest anything to you because I have not seen you as a patient. I can only make comments according to my experience.
      You are a young person, so even if you do not get an implant now, you may change your mind in the future and decide you want one.
      The second molar is a good chewing molar and if you extract it, the opposing molar may supra erupt (grow) into the space affecting your bite and preventing you from replacing the missing molar in the future.
      Basically if you know you are never going to get an implant, you do not need to spend your money on a bone graft for that tooth.
      Good luck!

  5. I have an upper middle molar that has had a root canal about 1.5 years ago and still causes biting pain and cold sensitivity. He now thinks the tooth has a small fracture. It’s been a problem for almost a year now. Redid the crown last summer, didn’t help.
    I have now requested that they just extract the tooth.
    Doc agreed and wants to also do a bone graft. I plan to do a bridge not an implant.
    My question: Why is a bone graft needed? I had the exact same thing done in the other side if my mouth about 2 years ago with no mention of bone grafting.
    I asked the doc why, he said it’s the new “standard of care”. (Sounds like legal mumbo jumbo to me)

    • Vern,
      If the extraction is not in the area of your smile and you don’t plan to put an implant there because you know you are getting a bridge, then you don’t need a bone graft. In the smile area an extraction the bone loss can cause the replacement tooth to look longer, so it is a good idea to minimize the bone loss with a bone graft for socket preservation.
      A comment on the bridge: If the teeth adjacent to the extraction are in need of crowns, then the bridge is a good idea, because it kills two birds with one stone, but if the teeth are intact, I prefer the implant in my mouth.
      Good luck!

  6. So I had a filling slip or come loose on tooth 30 and between my xrays last year which showed no cavity and the most recent one, a cavity formed so big that the only treatment is extraction and implant. I can’t afford the implant so I am going to have it extracted. They want to do a socket preservation on that area but that plus the 2 other procedures would basically wipe out my benefits and still cost me like $500. Is a socket restoration even necessary? can I just have it extracted? Are there any issues with #30 being extracted? Thank you

    • Rob,
      A bone graft for socket preservation after the extraction of a first molar is a good idea, especially if you cannot get an implant now, but in a couple of years you may be able to. The bone graft may make the difference between having enough bone for an implant or not having enough bone, and your first molar is needed to chew your food comfortably. Without the first molar your chewing ability will be compromised on that side.
      If your decision is based on your finances and insurance, that is for you to think about, but the recommendation to bone graft is a sound one unless you know for sure that you are never going to get an implant there.
      Good luck!

  7. I am 56 and have an impacted upper wisdom tooth (#1) that now needs to be extracted. A small partial eruption of the top of the tooth has developed this year, and there is now concern about future development of pericoronitis. My periodontist informed me that depending on how this tooth extraction goes, a bone graft may be needed. How likely is it that a bone graft will be needed to fill in a bone defect after extraction of this tooth? Thanks.

    • Hi Ifor,
      The answer to your question “how likely is it that a bone graft will be needed…” is that it depends on how much of a bone defect remains behind the second molar after the extraction. Also, there will be some naturally occuring bone regeneration in the extraction site. You may want to wait and allow the area to heal for about six months and then reevaluate the area. If the site has healed and there is not a periodontal pocket present (most likely), then I don’t think you would need a bone graft. Having said that, if you value the opinion of your periodontist, then ask about this option.
      Good luck!

      Carlos Boudet, DDS
      Dentist in West Palm Beach

  8. Samantha James-Tharp

    Does the whole where the tooth came from grow bone to fill the gap?
    I watched a video of how the area slumped is a bone graph only for dental implants and cosmetics?

    One doctor recommend it and the other did not what do you do with such conflicting info.

    • Hi Samantha,
      A bone graft is needed, as you already know, when you want to maintain the bone and gums for cosmetic reasons, or to place an implant.
      The implant also has an additional function, and that is to maintain the bone level for the long term, because it transmits a stimulus to the bone similar to natural teeth that keeps the area functional and the bone from slowly disappearing over the years.
      What you call conflicting information, is actually a difference of opinion between different doctors.
      It is well established in the dental literature that the bone graft and implant is the best way to go if a replacement for a tooth is desired. You also have alternative treatments. The key is to do your research and find a knowledgeable dentist that you trust, then get your information from him or her and decide if it is what you want.
      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


  9. I need to have my bottom left molar extracted. I lost the crown and it has become infected. I do not intend on replacing it. I am 81 and on a fixed income. Is it really neseccary to have bone graft? If I don’t do it,what complications would I encounter? Pain?

    • Dear Sharon:
      If you don’t intend to replace the molar, then I can see no reason why you would need a bone graft, taking your age into consideration. The complications that you could encounter would be related to an extraction. Your dentist needs to give you that information prior to the extraction as part of your informed consent.
      Good luck!

      • Also having molar 2, my last tooth in the row, removed with no intention of replacing. I’m 35. Do I need a graft? If I forego it will it impact molar 3? Thanks!

        • Angela,
          You may not have any problems if you don’t get a bone graft after the extraction, but you can have your bite affected when the opposing molar slowly grows into the space where the extracted tooth was. The opposing teeth supraerupt when they don’t have a tooth to bite against.
          Good luck!

  10. Question, Should a dentist be able to determine by an x-ray or some form if an extraction point has healed enough for a bone graph and post placement for an implant? Or, is it common to not be able to determine this until the dentist opens the area up and starts the surgery?
    I had two back molars extracted, and I am having them replaced with implants. I was scheduled to have graphs on both teeth, and the posts put in for the implants on both sides in one surgery. The dentist opened up my left back molar extraction spot, and determined that my own bone had not healed enough to ensure placement would have a 98-99% chance of success, so he put in the graph on that side, and we scheduled the surgery for 2 months out to put the post on the left side, and do the graph and post on the right side.
    I have no issue with the delay to raise the chance of success. I even appreciate it. The only concern or question is, shouldn’t he have been able to determine that I was healing slow, without opening the extraction spot open and creating all that trauma to the area?

    • Dear Robert:
      One way of determining if an extraction site has adequately healed is time. Bone grows very slowly, and it takes months for an extraction socket to fill again with bone. The problem is that the dentist wants you to keep as much bone as possible, and in the first three months after a tooth is extracted, you can loose as much as 25% of the bone that held the root in place. The same bone that has to hold the implant.
      So sometimes the dentist tries to place the implant as soon as possible, at a time when the bone is not fully regenerated. If the tooth had more than one root, the dentist may choose to graft and wait a few months in order to place the implant in the most ideal location, instead of following one of the root spaces and placing the implant at an angle in a less optimal position.
      So the answer to your question is yes, you can take an x-ray and see a two dimensional picture of the area, and you can tell if there is enough bone in two dimensions, but you need the third dimension (how wide is the bone) to be sure, and that can be determined when you cut and open the surgical site, or by taking a 3-dimensional x-ray called a CBCT. This specializes x-ray adds an additional cost to the procedure, and some experienced dentists do fine without it in many cases.
      I hope this helped, and thanks for the question.

  11. #15 (root canal/crown) has a lateral fracture and needs extraction due to infection. Apparently, infection has gone un-noticed longer than it should have. A recent MRI was done of my sinus, which made me aware of this. There was zero pain in the tooth area because of it being a root canal. So now, the bone between #14 & #15 has been partially compromised (only the #15 side) and grafting has been suggested in order to complete extraction; which will include the #14 & #15 teeth. #16 (wisdom tooth) is good and will be a floater; meaning left alone after the TWO others are extracted. : (

    I still have ALL (4) wisdom teeth. They are in great shape. The extraction would specifically be for #15 (lateral fracture) & #14 (good tooth but compromised bone loss on #15 side of tooth). The thought of extracting teeth just saddens me. I have had pride in having ALL my teeth and they look great. 56 yrs young!

    At any rate, my understanding is that the wisdom teeth are NOT necessary and can eventually be removed. The Dentist, Endo and Perio were all surprised that I still had ALL of them but made me aware that it is OKAY if I had them removed. Maybe not all at the same time but rather in the long-run.

    The reason: I have room to spare to give my entire mouth some breathing room for my other teeth, however, I would only consider extraction of the wisdoms teeth because of imbalance of appearance; meaning more teeth on other 3 sides, making it look cosmetically off. My only regret is that #14 was affected instead of the #16 (wisdom) tooth. So now, I will face extracting THREE (3) teeth (#14, #15, and POSSIBLY #16) on one upper side of the mouth; again, I have all the ORIGINALS teeth. This bothers me!

    I am confused on my best options toward keeping placement BALANCE of the teeth. #14 & #15 HAVE to come out. #16 does NOT but may be best to extract in order to do a complete grafting on that upper side. This is with the mind-set of extracting the remaining (3) wisdom teeth down the line to create placement balance of all the teeth. I do not have a problem removing the wisdom teeth since I have room to spare.

    Is there ANY way #16 can be REMOVED & PLACED in lieu of #14 or #15; meaning extract it and swap it’s place so I have an original tooth there in #14 instead of a possible implant? If not, would removing all wisdom teeth be unimaginable? My thought process is to end up with a balance of teeth on both upper & lower jaw. As it currently stands, just the upper left jaw will be compromised with implants or removal of any teeth.

    What are your professional thoughts on options? My mind is racing and I am trying to grasp all that is happening and all that needs to possibly be done. In the end, I want cosmetic balance of my teeth; even the back ones.

    Regards, HR

    • Dear KLH:
      I am not able to advise you on your situation because for that, I need to personally see you and your records. Also, I don’t quite understand some of the information you provide.
      I can tell you that #15 needs an extraction if the root is fractured, and that “the bone between #14 & #15 has been partially compromised” does not qualify as a good reason for extraction of #14.
      I also do not understand your concept of balance. Removing teeth #15 and 16 would not affect the cosmetic zone and your smile.
      As far as your suggestion of transplanting #16 into the area of #14 or #15, it might be possible, if you could find a dentist that did that.
      Again, make sure there is no possibility of saving #14 before condemning it to an extraction, and if you are not sure, it should be ok to get a second opinion from a knowledgeable dentist in your area.
      Good luck!

  12. Hi Doc. My dentist will be extracting tooth #18. I have an infection there that has eaten away at the bone apparently. He insists on bone grafting the site, otherwise he refuses to extract. If I don’t plan on getting an implant down the road, do I really need to bone graft there? By the way, I still have my fully erupted and normal wisdom tooth behind it. I’m desperate for an unbiased answer. Thank you.

    • Rami,
      If you do not plan to put an implant to replace your lower left second molar, then I do not see a need for a bone graft.
      Good luck!

      • Hi Doc, thanks so much for your reply. Unfortunately, I didn’t see this until today. I went ahead with the extraction on May 3rd and went back for a follow up on the 13th. They removed my stitches and said everything is healing properly but I’m a bit concerned about the “shape” of the extraction site 2 weeks in. Best way to describe it is a hole is still visible (gum tissue hasn’t fully covered yet) but no pain or particles coming out of the graft. I’m worried about things going into that small hole although I was told not to. In your opinion, is it normal for an extraction site/bone graft to look like that 2 weeks in? And if so, how long before things start to smooth out and all I see is a smooth “pink” cover over the site? Thanks again so much.

  13. Hello.

    I am very confused about some dental treatment I need. Tooth #29 needs to be extracted, #28 is missing (a bridge was there), and #27 needs a root canal re-do. (I am not having any issues, but the dentist says that the root canal–done more than a decade ago–was not done properly.) #30 is a root canal-treated crowned tooth. The dentist wants to do a bridge that spans all of the teeth (#27-#30). The bridge would be anchored by the two crowned, root-canal treated teeth (#27 and #30).

    The periodontist wants to do a bone graft immediately upon extraction of #29, and would prefer to do two implants (on #29 and #27) and anchor a bridge to those two implants. Seems silly to me to do implants if you are just going to put a bridge on anyway.

    Also, I am not sure what value placing bone into the extraction site will provide if we are doing a bridge. Doesn’t that material re-absorb anyway after awhile?

    As far as the “long bridge” option advocated by my dentist: I am also concerned about anchoring a bridge to two crowned teeth. My dentist swears it will be solid, but the periodontist says it won’t.

    My preference would be for the bridge, with no graft. I don’t like all the reports of bacterial-related diseases/infections from implants, and I do not like the idea of foreign substances in my gums. However, my periodontist says the bridge will fail in a couple of years; my dentist swears it won’t. So, I am massively confused right now as to what I should do. Although I have my preferences on what I want to do, I also am not a dental professional, so I want the best, safest, most reliable solution long-term.

    The implant-and-bridge route would be horribly expensive, but I could move some funds around to pay for it if I had to.

    I joked to a friend of mine today that THIS is why people get dentures! (Yes, I know they create a whole host of other issues.) But when dental professionals give conflicting advice, it makes you wonder.

    By his own admission, my dentist says my home care is “outstanding” and he can tell I take good care of my teeth. Yet, over the past four years, every time I go in for a cleaning, he always seems to find a tooth that needs a root canal or a crown. This is getting old, and I am starting to not trust him. However, he comes highly recommended and “seems” to have a good reputation.

    Any insights you can give would be appreciated.

    • Dear Concerned:
      I am sorry that you are so confused about what your dental treatment should be. I will give you some comments about your case that may help you get a clearer perspective about your situation. First, let’s talk about the recommendation for the long bridge by the dentist.
      With the success and research behind implants today, more and more dentists are starting to recommend not to rely on teeth that are weakened by root canal therapy for the support of a bridge, especially a long span bridge. A better, more conservative choice would be to keep #30 and #27 crowned as individual teeth and replace the missing 29 and 28 with two implants. If the root canal teeth ever fail, you just deal with replacing that tooth instead of a four unit bridge, and the chances of failure as individual teeth are less than a four unit bridge on two root canal treated teeth.
      You should not be wondering why you have received two different treatment plans. A dentist will give you a treatment plan based on his expertise, his training and his experience. You have a choice. You can go to a dentist that you trust and follow his recommendation if you believe he has your best interest in mind, or you can wonder and try to inform yourself as much as possible in the internet or go and get second opinions locally. Remember that this comment is not to be construed as a recommendation or advise, and you should see a dentist for that. I am sorry that you have trust issues with your current dentist.
      I wish you 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

      Spanish website:

  14. Hello,
    I was wondering if you could share with me if you think this is feasible: my father needs a bone graft for an implant for a back molar and his dentist would like to source a peice from his hip. However, he does not want to do this for financial and health reasons. I have two significant tori, so, is it possible for a) me to donate my tori for the bone graft (ie is there significant risk the graft will not take when a donation is provided by another individual) and b) would a buccal exotosis even provide enough bone of a suitable size/shape for a bone graft (I have one almost the size of a molar)? I know this is no substitute for an actual exam with a doctor, but your thoughts would be appreciated.

    • Hi Stephanie,
      I will be glad to share some information with you.
      I think you already understand that without examining your father, I can only give you an educated guess at the possible solutions.
      First off, even though you share many hereditary traits with your father, a bone graft from you still carries a risk of rejection. The cadaver bone graft that is used routinely has gone through many processes that remove antigenicity to prevent a foreign body reaction.
      Now, about the hip graft. When a surgeon goes to the hip to harvest the required bone it usually means that the defect is very large, there is not enough bone available from donor sites in the mouth, and is normally reserved for extensive cases.
      A new alternative for large grafts is the use of BMP. Recently Dr. Robert Marx at the University of Miami has been successful with large bone grafts utilizing a titanium mesh or crib and cadaver bone mixed with bone morphogenic protein or BMP for short. The advantage of this procedure is that it avoids a second surgery and wound site to harvest the donor bone from the patient.
      You may want to ask your father’s surgeon if he thinks this would be a good alternative for him.
      Thank you for your question, and I hope that my answer has been of some help.
      Best wishes for you and your father.

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


  15. Hi Dr. i had an impacted tooth by 2nd bicuspid removed right under my baby molar. My surgeon told me that he would also be doing a bone graft in the site… I did the procedure to continue with my braces treatment… but all the videos i have watched about bone grafting preservation involved putting bone in socket and covering with a membrane… and stitches on top of that… in my case i look into the removal extraction site and see a deep hole where my molar was… I dont know if maybe the bone was placed where the impacted tooth was instead of in the socket? Because my socket is deep and empty im worried that when braces move my teeth in to this space they wont have bone to support them. Thank you very much.

    • Hi Mari,
      The person that can easily answer your question is the same surgeon that did the procedure.
      I think you should ask the surgeon what he did, and let him know that you are worried that your socket is deep and empty after having the bone graft.
      If you are not happy with the answer he gives you, then maybe you can get another surgeon to look at you and give you his opinion.
      Try talking to the surgeon first.
      Hope this helps, and good luck!

  16. Hi Dr. Boudet,
    I went to the dentist today for the first time in 7 years (I am a bit phobic) due to some mild tooth pain in an upper molar. I found out that #15 has a cavity too large to treat and the recommendation is extraction. Whether to have an implant or not was left up to me. My wisdom teeth were removed many years ago and I understand that it is unlikely that there will be any shifting of teeth since “they tend to shift forward” and that is my last tooth to the rear. Also, my bite would not seem to be very impacted according to the dentist. That said, my initial response was that I should have a full set of teeth. Now I am wondering if that is unnecessary and a foolish waste of money, treatment and risk. What do you think about replacing #15 with an implant with no wisdom tooth? I am 57. Thanks so much!

    • Hi Meg,
      After 35 years in dentistry, I can tell you that the majority of individuals facing your situation opt for not replacing the second molar. I am sure that if finances were removed from the equation, the choice might be different.
      An implant in place of the second maxillary molar may not give you a big difference in your ability to chew your food and the choice to replace is a very personal one.
      The bone in that region is softer and very likely will be deficient after an extraction unless a bone graft for socket preservation is done at the time of the extraction, so the success rate is slightly lower and the risk of complication slightly higher.
      Another factor to consider is the fact that you allowed the tooth to get irreparably damaged by not getting regular dental care, and although the implant will not get decay, the gums around it can be affected by gum disease that eventually may result in the loss of the implant, so if you decide to replace the molar, make sure that you get regular checkups and maintenance.
      It sounds like you are well informed and I am sure that you will make a good decision that fits your situation.
      Good luck, and thanks for your question.

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


      • Thank you for your helpful reply – and I have learned my lesson about the need for regular dental care – phobia or no phobia. This is certainly worse.

  17. Great information! My dentist is saying that for my bottom two wisdom teeth that they will do a bone graft for each of them. I don’t understand why – I’m not planning on putting another tooth in there – the whole point is that there’s not enough room in my mouth. I want to go to this Oral Surgeon’s office because they put you completely out rather than being awake for the process. That’s all I want is to be knocked out and no bone grafts, way to much $$$ there.

    • Hi Marissa,
      The one reason I can think of where it would be beneficial to get a bone graft in the extraction site of a wisdom tooth is if the surgeon anticipates that the extraction will create a periodontal defect behind the second molar.
      That being said, if you do not want a bone graft you need to explain this to the surgeon, and you should not be forced into doing something that you do not want.
      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

  18. Hello! Thank you for all the great information. I went to the dentist and was told that I need to have 2 wisdom teeth removed and have bone graft on them…at $1200 a pop!! (WOW). I’m not able to pay for that, and was wondering if there would be a problem if I decided not to do the graft…I understand that it would create a more difficult process of keeping the area clean, but I’m willing to do that if it means I’ll save $2500. In other words, I’m not going to lose all my other teeth in a short time if I opt out of the graft…right?? 🙂

    • Hi Idalia,
      The only reason I can think of for bone grafting the extraction site of a wisdom tooth is if there is a high probability that the removal of the wisdom tooth will leave a defect in the bone that will create a pocket in the gums behind the second molar.
      The pocket would be difficult to clean and may need frequent scalings and root planings (deep cleanings), and GBR procedures (guided bone regeneration).
      There may be a chance that the area will heal without pocket formation also.
      In any case, the only tooth affected by this is your second molar.
      “I’m not going to lose all my other teeth in a short time if I opt out of the graft…right?? :)”
      Good luck and thanks for asking.

  19. Hi Dr. Boudet,

    I’m in a bit of a predicament and am hoping you can give me some peace of mind..I got all 4 impacted wisdom teeth removed about 6 years ago and since then, I think my jaw is narrower and cheekbones less pronounced. To be honest I’ve always been a bit vain and still think I’m pretty but am devastated I went through with the surgery. Is it possible to have bone grafts and then implants put in to regenerate the bone? I have read this is possible..also, do you think I am exaggerating these after effects or have you noticed this in other patients as well? Do you know why this consequence isn’t mentioned in informed consent? Thanks so much for your time.

    • Greetings.
      There is no possible way that your jaw can be narrower from the surgical removal of your wisdom teeth unless your jaw was broken in the procedure.
      Your cheekbones are also not in an area that can be affected by removal of impacted third molars.
      That is why what you describe is not mentioned in informed consent for third molars.
      If you feel that there have been changes in these areas, they could be related to other causes such as weight loss.
      If you are not happy with these changes and want these areas to look better, you may want to consult with your physician about it.

  20. Hello,
    So, I’m suppose to get my molar extracted #15 I think it is. Because I waited too long to get a crown they have to remove it. They recommended I get it extracted and put a bone graft for an implant. But as we all already know they cost too much. I was wondering can’t I just have the tooth pulled out and that’s it of that tooth? No implant and no graft need? Will the rest of my teeth be affected? I heard that the bottom one will. And may have to get that extracted in the long run. But I guess my main concern is do I really need to get bone graft now after extracrion and then have implant OR can I just have it pulled out, along with the bottom one (bottom molar) later on? Thanks !

    • Hi Kristy,
      The answer to your question is yes. Taking the molar out and not grafting the socket is one of your options.
      The only reason you would need a bone graft with the extraction is if you are planning to get the implant.
      There are consequences for not replacing the molar, but you already know about them (the opposing tooth growing into the space of #15, the bite shifting, etc…).
      Extraction without replacement is not the best choice, and yes replacing the molar with an implant is not cheap.
      Now that you have the information, you can better make your decision.
      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


  21. Good day Carlos,

    Would appreciate you opinion on something. 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 jsut 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.


    • 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

      Spanish Website:


    • Hi Kathryn,
      There is usually more than one way to treat a patient with conditions similar to yours.
      In the upper jaw, the bone quality is poorer and the bone softer, so dentists like to place a greater number of implants and longer implants than in the mandible.
      One of the most common ways to place implants to hold a denture in the maxilla is doing bone grafts on both sides of the mouth in the molar areas and placing six or more implants to hold and support a denture. The area of the front teeth is avoided to have enough room to place the front teeth in the correct position because the implants would come out at a bad angle.
      If you do not like this option, there is a graft-less solution that allows the placement of several implants in the available bone in front of the sinuses at an angle and the implants help hold a denture that is screwed in and does not come off, or a bar with attachments that holds the denture in place and you don’t have to cover the roof of the mouth with pink acrylic.
      Anyway, you need to start by developing a treatment plan that works for you, and only your dentist can do that after an examination and the necessary x-rays.
      I hope this answers your question. If we can assist you further, don’t hesitate to call our office.

      West Palm Beach Dentist
      Carlos Boudet, DDS
      1840 Forest Hill Blvd Suite 204
      West Palm Beach, Florida. 33406


  23. Hi,

    I am 38 years old and had my lower left and right wisdom teeth removed about 3 years ago. According to my dentist, I had significant bone loss due to the late removal as well as infection. There is now not much bone holding my lower 2nd molars and as a result are slightly mobile (resulting in food easily getting stuck between the 2nd and 3rd molar. This also allows bacteria to trap beneath the gums in areas that are difficult to clean which could result in continued loss of bone and eventual loss of tooth.

    Would it be possible for bone grafting to generate sufficient bone behind my 2nd molars and also between the roots so that they are firmly held in place and also resulting in a higher gum line?


    • James,
      I am sorry to hear about your gum and bone loss.
      Bone grafting around teeth can sometimes be done to fill vertical defects in the bone that have walls of bone around them. If your bone loss is horizontal and there are no walls to hold the graft, you cannot graft bone on top and expect it to regenerate what you have lost. However, please realize that I cannot tell you what can and cannot be done in your particular situation without the information that a clinical exam and x-rays provides.
      The best thing to do is to get an evaluation by a good periodontist and let him/her tell you what can be done in your particular case.
      Good luck!

      Implant Dentist in West Palm Beach
      Carlos Boudet, DDS
      1840 Forest Hill Blvd, Suite 204
      West Palm Beach, Florida 33406
      Phone: (561) 968 6022

      Spanish Website:

  24. Wow…I’ve already gotten great info just reading prior questions and your answers…you seem like an amazing, informative and trustworthy Doctor. Here’s my question Doc…#13 never came down all the way and #14 is at a forward angle. I’m 52, and every dentists I’ve ever seen said I would eventually have problems, I brush/floss daily and get cleanings every 6 months, but it’s impossible to get in because of the angle. There is now major decay( I feel lighting bolt pain when I suck it with my tongue). My dentist wants to extract #14 and put a bone graft in it’s place ($1000, his price, which seems incredibly high). I’m poor and unless I win the lottery, I don’t intend to get implants (he said $3000-$5000 and I may need 2 if #13 eventually has to come out). I’m hoping maybe #13 will come down once #14 is out and maybe I can do something later if it doesn’t. So the big question is do I need to get that bone graft? Thank you for your help, Stacy 🙂

    • Hi Stacy,
      I would never dare to make a recommendation to you whether you need a bone graft or not without looking at you first.
      But you have read already some of the information I have in other posts about similar situations.
      A bone graft in that area may be very necessary if you want to replace the molar with an implant, since the maxillary sinus is in the way and limits the size of the implant that can be placed. If you have baerly enough bone now under the sinus and you don’t graft, you will need a sinus graft later, which is a more costly surgical procedure and a higher risk of complications.
      If however, you don’t intend to get an implant, then you don’t need to spend the money on the graft.
      Whatever you decide, make sure that you and your dentist have a plan of what will be done in the future.
      Good luck
      Dentist in West Palm Beach Florida
      Carlos Boudet, DDS DICOI

  25. Hi,
    I have recently went to 2 highly recommended oral surgeons for wisdom teeth extraction consult. The first one did not mention bone grafting, and the second one recommended it; I have not revisited the first surgeon because I decided to go with the second one. I am 32 years old, and all my teeth are impacted. My panoramic x-ray looks very similar to this one:
    where BOTH bottom wisdom teeth are horizontal forward, and BOTH top wisdom teeth are just impacted, NOT erupting through gum line. The oral surgeon said that the bottom second molars appears to have been slightly eroded.

    I am going back and forth about bone grafting. I don’t mind paying the extra cost if it is a necessary and helpful procedure. I have read several websites and most people do not seem to require bone grafting, and I wonder if it’s because of my age and the condition of the second molars. However, if a dental implant is not needed in the future, is it still necessary for me to do the bone grafting?
    For what it’s worth, the oral surgeon did not make me feel like he was trying to extort more money from me, but I was still weary about it since I have never heard of the procedure before and didn’t know that people needed it after wisdom teeth extraction. He is leaving the decision to me, but highly recommends it.

    Your advice is much appreciated.



    • Hi Elle,
      The only reason to place a bone graft is still to avoid bone loss and a bone defect in that area.
      The fact that you don’t plan to place implants in that area (which nobody does anyway) does not mean that you may not need it.
      A dentist (classmate) friend of mine had his horizontally impacted lower wisdom teeth removed in a situation similar to yours, and back then no-one ever heard of doing a bone graft after an extraction.
      Years later he told me that those horizontally impacted third molars left a bone defect in the back of the second molar that contributed to him developing a periodontal pocket behind the second molar and now he has to struggle to keep the area clean on a daily basis.
      Ask your oral surgeon if he thinks that you are likely to develop a periodontal problem behind the second molar if you don’t get the bone graft, and if he says no, then I don’t think the procedure would be of much benefit to you.
      I hope this helps you and good luck!

      West Palm Beach Dentist
      Carlos Boudet, DDS DICOI
      1840 Forest Hill Blvd suite 204
      West Palm Beach, Florida 33406

  26. I recently had my #3 molar extracted and a bone graft performed at the extraction site in preparation for an implant. During the procedure, the dentist performed the extraction but let his surgical assistant perform the bone graft while he checked on another patient. He then returned to install the stitches. Is it normal to have a surgical assistant perform a bone graft?

    • Hi Sam,
      I do not know of any dentist that allows the dental assistant to place bone grafts, and in my office I place the bone grafts personally, but I would not be able to comment on the legality of having this procedure done by the assistant without doing further research on the subject.
      The best source for that information would be the American Dental Association and the Board of Dentistry of the State where the procedure was done, as the rules change from state to state.
      I hope that everything is fine and you had a successful outcome for your bone grafting procedure

  27. Both my lower 6-yr molars (#19 & #30) are broken & almost abcessed. My regular dentist of 30 yrs refuses to pull, but wants to crown them at $600 @, after our BCBS ins pays! I went to see the oral surgeon who removed my wisdom teeth for a 2nd opinion. His options were: 1) root canal by another specialist (100%), w/a crown (50%) by my dds; 2) crown (50%) by my dds or 3) extraction (100%) by the oral surgeon w/grafting & implants later. The ins does not pay for grafting ($542), implants ($4124) or the anesthesia ($706)! I understood the grafts were skin to fill in the holes, but looking online, it’s actually a bone graft. I just want them pulled, due to finances. Thoughts?

    • Dear Kathy:
      It sounds like you have already made up your mind that you want them pulled because of the cost.
      Going by your description, your dentist wants to save them, and removing and replacing them would be more costly.
      Your dentist is the person best able to make a recommendation since he has seen your mouth and I haven’t, but I tend to agree with a recommendation to save them.
      Good luck!

      West Palm Beach Dentist
      Carlos Boudet, DDS DICOI
      1840 Forest Hill Blvd suite 204
      West Palm Beach, Florida 33406

  28. Hi.

    I have an infected molar and they stated that they can maybe save it with a root canal but are not sure so I am just going to have them extract it once the infection goes away. They are insisting that I do a bone graph, but do I really need to do that if I don’t plan on getting an implant later. It is a back molar so it wont really affect my other teeth- correct?

    • Hi Becki,
      When you have a molar extracted, the bone around the extracted roots will remodel and shrink. The reason for the bone graft is to minimize the amount of shrinkage that the bone will undergo at the extraction site. If you are not planning to replace the missing molar with a bridge or an implant, then you may decide not to have the graft done.
      As far as the extraction affecting other teeth, it does affect the adjacent teeth by allowing them to drift and tilt into the empty space as the years go by, sometimes affecting your bite. The front teeth are not usually affected, but the more teeth missing, the more likely that they will.
      I hope this answers your questions.
      Good luck!

      West Palm Beach Dentist
      Carlos Boudet, DDS DICOI
      1840 Forest Hill Blvd suite 204
      West Palm Beach, Florida 33406

  29. I had my wisdom teeth extraction about almost 2 weeks ago. My doctor insisted me to have a bone graft done in those area. Is that necessary?

    • Jen,
      Wisdom teeth are usually extracted for different reasons, such as impacted with a risk of damaging the roots of the molar in front, pericoronitis from lack of room, etc…
      Once they are extracted, they are not replaced, since you can function perfectly well without them.
      The only reason I can think that you would need a bone graft after a wisdom tooth extraction is if the removal left a defect in the bone that might create a periodontal problem behind the second molar.
      You could also wait until the area heals for about a year and then do the graft if the defect in the bone is evident.
      Good luck!

      West Palm Beach Dentist
      Carlos Boudet, DDS DICOI

  30. gonna send this to my mom

  31. dental hygienist

    My cousin recommended this blog and she was totally right keep up the fantastic work!

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