Question from personalcorr

[Dr Pav Khaira]

Personalcorr asked

"In Oct 2007 my two lower front canines were found to be vertically fractured and have two cysts. On 30 Oct 2007 the two cysts and canines were extracted leaving a wide gap, with no temporary teeth. I plan to have tooth implants, and I will very likely need a bone grafting surgery before this, and these take time.

I have the following questions:
- Can I just do nothing, i.e. leave a wide gap between my two lower front teeth for up to 18 months before dental implant-supported prostheses are constructed ? Will adjacent teeth shift and will there be dental problems ?
- How many months after tooth extraction will the teeth start to shift ? How many months after tooth extraction will dental problems arise ? Will using a mouth guard (before the prostheses are in place) prevent tooth shifting and dental problems, and will it affect bone graft and dental implant surgeries ? When should I start wearing a mouth guard ?"

[Dr Pav Khaira]

The answer to your question is fairly simple. Once a tooth has been removed, you have 6 months or so to place implants before the bone disappears and placement of implants becomes difficult.

Once the implants have been placed, you can buy some time before restoring them. In the meantime, a denture can hold the space required to restore the teeth

I hope this answers your questions

[Dr Kalpesh Bohara]

Pav is right that ideally you want to consider placing implants soon after removal of teeth because bone can resorb.

But not all patients can afford implants immediately. Therfore there is the option of socket grafting after extraction. For many of my patients in these circumstances, we place bovine bone in the socket and let it heal. This allows to mantain the width for a longer period of time and allows delaying the implant placement.

Each patient is different in the way there bone resorbs. For example, recently, i placed 8 implants in the upper jaw for a 60 year old patient who had all is teeth removed 30 years ago. He had alot of bone available. Therefore each case is different.

Dr Kalpesh Bohara BDS MFDS RCS

[Dr Pav Khaira]

Kal, I think summing up what we have both said is ideally the implants want to be placed sooner rather than later, but if thats not the case its not necessarily the end of the world

[personalcorr]

Many thanks to Dr Pav Khaira and Dr Kalpesh Bohara for their replies.

From what I understand, it is better to place tooth implants sooner than later after tooth extraction because of bone resorption and adjacent teeth shifting. However, I also read on the internet that during healing new bone forms and this will take about 6 months to complete.

How fast is bone resorption happening ? Is there a big difference between the first 5 months and first 6 months ? So are we losing more bone than getting new bone, and thus should place implant(s) sooner ? I lost much bone due to the two cysts. Should I wait 6 months for the new bone to form before placing two implants ?

[Dr Pav Khaira]

New bone doesn't form unless you are grafting it in. As Dr Bohara has mentioned, bone loss takes about 6 months after extraction, at which point you will be more likely to need a graft.

If a graft is placed, it needs about 5 months on average to "unify" with the existing bone. Bone loss due to tooth removal and bone generation from a graft are 2 different processes

I hope this answers your question