Bone Graft during or after surgery for extracted teeth?

[Salemare]

I have having orthognathic surgery to correct my class II 1cm overjet. I have had 8 teeth removed in preparation for surgery.

I wanted to ask if its possible to have a bone graft during or after surgery to help reduce the long term aesthetic effects of tooth extractions.

Does the main aethetic protective benefit come purely come from the grafted bone material or the physical dental implant also?

Should my orthodontist have offered me a bone graft when carrying out each of these extractions, or would the bone graft be counterproductive to my corrective surgery??

[GJ]

Bone grafts won't take at an extraction site unless the area has bite force. This is why the bone resorbs in the first place. Without a tooth there, there is no bite force in the area, so the body interprets this as not needing the bone and it resorbs. Most of that resorption takes place in the months after the extraction. So IMO no a bone graft won't take unless it's part of some other structure (implant, bridge, etc) that puts bit force on the area.

[kavan]

Bone grafts (or material used instead of your own bone), in particular the type associated with tooth extractions are used right after an extraction BUT WHEN they want to replace with with a tooth implant. They are placed in the empty tooth SOCKETS so a tooth implant has bone material for a successful 'take' of the implant. However, that was NOT your particular situation when you got the extractions.

[Salemare]

Bone grafts won't take at an extraction site unless the area has bite force. This is why the bone resorbs in the first place. Without a tooth there, there is no bite force in the area, so the body interprets this as not needing the bone and it resorbs. Most of that resorption takes place in the months after the extraction. So IMO no a bone graft won't take unless it's part of some other structure (implant, bridge, etc) that puts bit force on the area.

Ok GJ, thanks for clarifying

[Salemare]

Bone grafts (or material used instead of your own bone), in particular the type associated with tooth extractions are used right after an extraction BUT WHEN they want to replace with with a tooth implant. They are placed in the empty tooth SOCKETS so a tooth implant has bone material for a successful 'take' of the implant. However, that was NOT your particular situation when you got the extractions.

Hi Kavan,

Ok thanks, so potentionally could I have dental implants/bone graft post surgery to replace the teeth I had extracted? From what I have seen online it seems there are orthodontists doing this, but of course I would need braces again to make the space again to put back the needed implants.

Following surgery is it necessary to wait until everything has healed and bring all the teeth together, or could the braces be applied in such a away to then make space for implants to be fitted during the post surgery brace period?

[kavan]

I could be wrong, but I don't think there is much potential or 'need' to open spaces up to replace the teeth. GJ already told you it is not a good idea to be in braces too long and that might apply to being 'in and out' of them as to this 'goal' of opening up spaces for the teeth they needed to remove so you could have the surgery you're getting. However, you should cross reference this with your surgical team though.

To the best of my knowledge, they don't replace wisdom teeth.
To the best of my knowledge, if they gave you a FUNCTIONAL BITE even though the pre-molars were extracted to do it and also advanced your jaw/s where that was needed, it might be best to maintain 'as is'.

Hi Kavan,

Ok thanks, so potentionally could I have dental implants/bone graft post surgery to replace the teeth I had extracted? From what I have seen online it seems there are orthodontists doing this, but of course I would need braces again to make the space again to put back the needed implants.

Following surgery is it necessary to wait until everything has healed and bring all the teeth together, or could the braces be applied in such a away to then make space for implants to be fitted during the post surgery brace period?

[GJ]

Ok thanks, so potentionally could I have dental implants/bone graft post surgery to replace the teeth I had extracted? From what I have seen online it seems there are orthodontists doing this, but of course I would need braces again to make the space again to put back the needed implants.

Following surgery is it necessary to wait until everything has healed and bring all the teeth together, or could the braces be applied in such a away to then make space for implants to be fitted during the post surgery brace period?

What would be the goal of the implants?

The bicuspids were pulled because of crowding. So now you have excess space that was closed by retracting the teeth. This is the problem with extractions. You go from too little space to too much. Too much retraction is needed to close the space. So ideally (before extractions and with proper planning) you'd get some type of maxillary expansion if possible to fit all the teeth or maybe IPR to shave them down to fit if it's not excessive crowding. Another option was mini implants once the teeth were extracted. All of these probably would have been better than extraction and retraction.

There are many dentists doing less than ideal treatments, and you are the victim of it.

If you want to put the teeth back in because you're realizing all this and it's upsetting, the best path is probably to take off all braces to stop the pathology (root resorption etc) and have them use springs to do a controlled opening of the space, and then put in mini implants. I think that might be the best treatment given your compromised position. The other option is to accept this is the treatment plan that you're getting and see how surgery goes then reassess.

Without knowing the goal it's hard to say. It sounds like you are just stressed and upset that this happened to you, and I certainly get that. Doctors should not be removing parts of our body like this without serious education and discussion about the matter.

[Salemare]

What would be the goal of the implants?

The bicuspids were pulled because of crowding. So now you have excess space that was closed by retracting the teeth. This is the problem with extractions. You go from too little space to too much. Too much retraction is needed to close the space. So ideally (before extractions and with proper planning) you'd get some type of maxillary expansion if possible to fit all the teeth or maybe IPR to shave them down to fit if it's not excessive crowding. Another option was mini implants once the teeth were extracted. All of these probably would have been better than extraction and retraction.

There are many dentists doing less than ideal treatments, and you are the victim of it.

If you want to put the teeth back in because you're realizing all this and it's upsetting, the best path is probably to take off all braces to stop the pathology (root resorption etc) and have them use springs to do a controlled opening of the space, and then put in mini implants. I think that might be the best treatment given your compromised position. The other option is to accept this is the treatment plan that you're getting and see how surgery goes then reassess.

Without knowing the goal it's hard to say. It sounds like you are just stressed and upset that this happened to you, and I certainly get that. Doctors should not be removing parts of our body like this without serious education and discussion about the matter.

Thanks.

In terms of goals, at the moment, Im thinking what I can do post surgery. As I understand it there is not really anything I can do now being so close to surgery. I have a small bite and a small jaw. My lower jaw teeth are very small, like childrens teeth and now I just have small front teeth that then are followed by much larger and uneven molars behind which looks a bit strange. There is no transition, because my lower front teeth and remaining premolars are so small and then I have normal sized molars behind.

My upper teeth have quite a lot of space between each of them still but on my lower jaw the teeth thave been retracted. I made a mistake in my previous emails as I had 7 teeth removed and have 1 wisdom tooth left on the lower jaw to remove. The orthodontist said that I will be soon ready for surgery so I guess at this point there is no point to try anything. Probably at best I could perhaps try for some mini implants post surgery.