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Dentistry/re: Bone graft for wisdom tooth removal???

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Question
Hello Joel!  I'm wondering whether it's considered 'normal' to get a bone graft for a wisdom tooth removal.  Some background:  I am 28, and had just had 3 wisdoms removed last week. (the 2 upper, and bottom left wisdom tooth)  The horrific experience took 2 hours, not the estimated 45 min(!)
My dentist has just told me that the others were unexpectedly difficult (all were fully erupted, but all had long/curvy/stubborn roots!) He also informed me that for such a small mouth... damn.. 'you have huge wisdom teeth!!!'

The dentist said that for my last wisdom tooth, he thinks he'll probably need to give me a bone graft.  He says that he will probably have to make a huge 'hole' just to get the last wisdom tooth out safely (roots are awfully close to the nerve). And, he said that even though you're 'young' and could probably grow the bone back, he doesn't want to take the chance of having the hole not heal up properly.

So......... how common is it for ppl to remove wisdom teeth, & have to get a bone graft?  I think I've done my googling thoroughly, and didn't read anything about this being common.. I think I'm being skinned..... b/c dental bill is already sitting at $1600 for 4 silly teeth, out of my own pocket. =X

Answer
Melissa -  It all depends on the anatomy in the area and the skill of the doctor to determine if a graft is needed.  Usually a board certified oral and maxillofacial surgeon will plan to not remove excessive amounts of bone, unless there is not other method.  A good surgeon, instead of removing bone, would divide the tooth into a number of pieces and remove each piece separately.  Not only is excessive amounts of bone not removed, a proper sectioning of the tooth decreases the amount of force necessary to extract the tooth and again, if done properly, excess forces  are not applied to the nerve in the bone.  

So a graft should usually not be necessary with a good surgeon, but it is possible with any surgeon if the tooth is excessively difficult to remove.  

I hope that, at least, you are comfortable.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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