Not enough bone for implant after tooth was pulled

Q: I was mad at my doctor last week. He pulled a tooth four months ago on my upper right and told me he would be able to place the implant followed by a crown four months later. When he took the x-ray after four months of waiting, he now tells me all the bone shrunk and I cannot have an implant. What happened?

A: First Today’s CNN Headline: An Alaska dentist who extracted a patient’s tooth on a hoverboard sentenced to 12 years in jail.

When I first read about this nut job, I thought he was on a hoverboard (a glorified motorized skateboard) in order to treat multiple patients at the same time in multiple rooms more efficiently. Much like the servers on roller skates at fast food restaurants in the fifties, like a scene from American Graffiti.

One might ask: Why such a stiff sentence? Answer: He had a record of antics with Medicaid fraud and removing patient’s teeth without their permission resulting in a suspended dental license in 2017.

I confess; I once removed a tooth without wearing deodorant. (I was in a rush that morning.)

In my 32 years of experience, my colleagues and I will agree the upper jaw, the maxilla, has soft bone like balsa wood. (Loved those balsa wood gliders as a kid form 7-Eleven on Long Island!) It is important to add bone graft material and cover it with a collagen membrane in order to build a solid foundation to anchor an implant. If you don’t, the ridge of bone often resorbs to the point that the sinus cavity is in the way of placing an appropriate length implant.

Several types of graft materials are used including freeze dried cadaver bone, bovine bone, hydroxyapatite synthetics, ground-up pieces of the patient’s tooth that was removed and the patient’s own bone or plasma.

Even if a patient has financial issues at the time of the extraction and cannot afford an implant, it is important to still graft the site in case their financial situation changes.