Question : With a tooth implant: is the implant screwed into the hole left by the roots of the pulled tooth?
Is the implant screwed into the hole left by the roots of the pulled tooth or does the periodontist have to drill deeper into the jawbone?

Additionally: if more bone has to be grafted to the jawbone, where does this bone-graft come from? Is it synthetic?

Also: what are the odds of damaging the mandibular nerve when implanting a lower molar?
tooth implant

Best answer:

Answer by Steven B
Three answers for the price of one! ;-)

1) Not all implants are placed at the time of extraction. While it is possible that an implant fixture placed immediately may be screwed into the extraction socket, the socket has to be exactly where the surgeon wants to put the fixture. It may be necessary to lengthen and shape the socket with a trephine to size it to the fixture being used. It may be necessary to do bone grafting at the same time. I would say that in most of my implant cases, the surgeon has NOT placed the implant at the time of extraction.
2) Bone grafting material can come from a variety of sources. The best source is to use your own bone from somewhere else–but most patients don’t go this route, since it requires a second surgery to remove bone. There are other sources of graft material. Ideally they should be osteogenic–ie: they should stimulate your jawbone to create new bone. Sometimes the surgeon will use demineralized freeze-dried bone (usually cow bone). And sometimes artificial minerals are used–these last do not induce new bone growth but can be mixed with natural graft materials. Often the graft is covered by a membrane that prevents the surface cells from growing down to the graft.
3) If you have a good surgeon, the chances of damaging the inferior alveolar nerve should be very, very small. If there is any doubt about the size, shape, morphology of the jaw, location of the inferior alveolar canal etc. the surgeon should do whatever radiographic studies are necessary so that he/she knows exactly where that nerve is. The most information can be obtained by a CT scan.

Hope this helps,
Steve Bornfeld, DDS