Bone grafting and implant placement performed at the same time or separately a few months apart ?

[dingdongbell]

My LR molar #46 has been missing for many years. Now I plan to place a bone graft and a dental implant in its place.

I am taking the drug methotrexate 7.5 mg every week. Does methotrexate affect bone graft healing adversely ?

If bone grafting and implant placement are performed at the same time, and methotrexate causes the bone graft to fail, my big investment on the implant will be lost. Can this implant be reused for another missing tooth #37 (extracted on 14/11/2022) that does not require bone graft ?

On the other hand, if bone grafting and implant placement are performed separately a few months apart, the overall treatment time will be lengthened. Also, will two procedures cause more risks and more harm to the tissues than one procedure and cause unsatisfactory prognosis to the implant ?

 

[MattKW]

1. Not many studies on methotrexate (MTX) and dental implants are available. I attach 2 articles: first one is specifically MTX in a small study using dogs; the second is a review of many articles in immunocompromised people and animals but not specifically MTX.
2. Once an implant has been used, the surface is contaminated and it cannot be reused.
3. Not sure about separating the graft and implant. It would seem that if your MTX could be lowered as far as possible, then I would do it all in one op.
4. Ask the dentist or whoever is doing your implant what they think. I would want someone with considerable knowledge in plant surgery like a periodontist or oral maxillo-facial surgeon, rather than a general dentist who might have more limited experience.

 

[dingdongbell]

1. Not many studies on methotrexate (MTX) and dental implants are available. I attach 2 articles: first one is specifically MTX in a small study using dogs; the second is a review of many articles in immunocompromised people and animals but not specifically MTX.
2. Once an implant has been used, the surface is contaminated and it cannot be reused.
3. Not sure about separating the graft and implant. It would seem that if your MTX could be lowered as far as possible, then I would do it all in one op.
4. Ask the dentist or whoever is doing your implant what they think. I would want someone with considerable knowledge in plant surgery like a periodontist or oral maxillo-facial surgeon, rather than a general dentist who might have more limited experience.

Thank you very much for your reply and the two articles with important points highlighted.

I thought about separating bone graft and implant because I was worried that if the two were done in the same operation and the bone graft subsequently failed, I would have to pay for the implant as well. I just mentioned this to my dentist and he told me that in such a case, I would only have to pay for the bone graft and I would be refunded for the implant. He also talked about the disadvantages in having two operations and he recommended one operation.

I am already on a low dose of methotrexate. I don't know whether it can be lowered, but I will discuss this with my doctor.

Thanks again. It is good to have you on this forum. You have helped many people.