Extraction with or without bone graft?

Feb 7, 2023
I need to have my upper-left first molar (UL6) extracted, as due to a cracked root the tooth is unrestorable.

After the extraction, I’m considering getting an implant or I may get some orthodontic treatment first to straighten my front teeth and possibly see whether the extraction gap can be closed orthodontically. Or I may just leave a gap if I can get used to it, but I'd like to keep the option of an implant open.

I’ve seen a specialist who feels I’m likely to be a good candidate for an implant; a CBCT scan shows there is ‘extensive external root resorption affecting both the palatal aspect of the crown and most of the palatal root’ of the cracked first molar, but apparently this isn’t in the more central area where an implant would be placed.

In case they’re of use…

A CBCT image of the area: https://photos.app.goo.gl/66pfKEmQrWLmVKFx9

An OPG x-ray: https://photos.app.goo.gl/2EFikk5wexSMc9Ho6

I’ve been offered the option of a graft in the socket at the time of extraction. The specialist says this may help preserve the bone and gum volume, making me slightly less likely to require a bone graft if I decide to get an implant (still thinking about that). And also that I may have a slightly better final aesthetic outcome due to less tissue shrinkage. The graft would be with Bio-Oss (artificial bone made from bovine/cattle bone, which apparently is widely used). He's made clear, however, that I'd need a CBCT scan a few months after the extraction to assess the amount of bone, and that there's no guarantee that a graft done with the extraction would save me from getting a graft later.

I wonder if any dentists could share whether they’ve found a bone graft at the time of extraction (called a ‘socket preservation’ graft I think) to be of value and provide better outcomes?

I’m happy to pay the money if it is worth it, but the benefits seem a bit vague, plus I’ve found some seemingly reputable sources online that suggest maybe it’s not such a good idea. This one for example: https://www.nature.com/articles/s41415-022-4967-2

Many thanks for any input/thoughts/suggestions.


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