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If there’s one principle, I’ve stood by throughout my career, it’s this: preservation starts with vision. Vision that is afforded to us through advances in 3D imaging, by clinical experience, and by a commitment to long-term outcomes, not shortcuts. That’s why I graft virtually every extraction socket I encounter. And it’s not about revenue. It’s about respect for biology and planning for the future.
A common misconception I still hear is: “I’ll graft only if I plan to place an implant.” That logic is flawed. Every time we extract a tooth, we initiate bone loss. Not just a little – potentially 40 to 60% of the ridge volume. AND, if the buccal plate is lost, it does not regenerate without our intervention.
Even when patients think they “might not” want an implant, I tell them: you may not want a tooth now, but you’ll probably want options later. Socket grafting preserves those options as well as helping to maintain the surrounding area
Planning isn’t glancing at a PA or a panoramic radiograph. It’s not “eyeballing” a ridge. It is the process of digitally dissecting a case with CBCT with advanced segmentation tools that let you virtually extract, visualize, and calculate. Without a 3D cross-sectional view, you cannot truly appreciate the trajectory of the tooth vs. the alveolus, or how you identify thin buccal plates, the bone density, or whether that molar root is dilacerated or hugging the maxillary sinus.
This 3D awareness helps prevent “air integration,” or placing implants outside of bone. Yes, it happens, and I’ve seen it more times than I care to count on social media and in second-opinion patients.
