Expert: Rafael Mosery,D.D.S. - 10/11/2008

Question
Immediately after the difficult extraction of tooth 13 (came out in 3 pieces), my dentist asked if I wanted the implant post placed since I was there and already numbed. After I agreed, I over heard his assistant tell him that the post size he requested was not available, but proceeded with an alternate size and told me he was packing bone graft material to firmly anchor the post. A week later,he added more bone graft during a follow-up exam, and 2 weeks afterwards, when out dropped out added more bone graft, stitched me up with out the post and told me I must wait for the graft to set before placing the post, about 4 months which is now. I am feeling like he tried to skip steps and I really want to go to another Dentist to place the post and complete the implant. I would appreciate your thoughts on what was done, and recommendation for my next step.

Answer
Tooth # 13 lends itself to an immediate placement option if there's adequate bone.The number of pieces the tooth came out in has no bearing whatsoever on the implant placement.You should have been given the option of immediate placement-which you had done or routinely waiting 6-8 weeks after the extraction and then implant placement followed by another waiting period of 6 months.Immediate placement is more fraught with risk as everything has to be just right.I use this option more with anterior teeth than with premolars.It's great when it works out and it's lousy when it doesn't.You should have the choice and the risks explained to you before and then make the decision.At this point wait 6-8 months for the bone graft to heal and then proceed with routine placement.