Dental Surgery

Why would you travel from Kansas City, say, to St. Louis “just for an extraction”?

In our office, we make every effort to save our patients’ teeth, but sometimes, tooth removal is unavoidable.

There are several reasons why extraction may be recommended, including

• Extensive decay that makes a tooth non-restorable.
• Advanced gum disease, where tooth mobility creates a hopeless prognosis.
• An abscessed tooth with infection that the patient prefers not to have treated with a root canal.
• An infected root canal tooth.

Whatever the situation, it’s imperative that any extraction be performed painlessly and that the bone at the extraction site is cleaned thoroughly, removing the periodontal ligament to prevent any bacterial growth or infection during postoperative healing.

 A New, Biologic Approach to Extractions

A groundbreaking 2025 study led by Dr. Shahram Ghanaati, an internationally recognized expert in biologic oral surgery, has reshaped our understanding of how the jawbone heals after tooth extraction. Using advanced 3D imaging (CBCT), Dr. Ghanaati and his team discovered that the body does not reliably regenerate solid bone after tooth extraction (PMID: 40001648). Instead, the extraction site often collapses, losing both height and width, and frequently remains hollow in the center.

These unhealed areas, called cavitations, are much more common than previously thought. Left untreated, they can compromise future treatments such as implants, serve as hidden sources of chronic inflammation, and may even affect whole-body health.

This marks a turning point in biologic dentistry. For too long, dental surgery has been treated as something less than surgery elsewhere in the body. It is considered routine, minor, and separate from broader medical principles. But the truth is clear: The mouth is part of the body, and oral surgery is no different in importance than any other surgery.

Our Response: A Biologic, Research-Based Healing Protocol

To lead this shift, Dr. Michael Rehme, Jr., completed an advanced surgical residency at Tufts University School of Dental Medicine under the direct mentorship of Dr. Ghanaati. This specialized training ensures that our approach is grounded in the most current, science-based techniques in regenerative oral surgery.

As a result, we now apply the Ghanaati Open Wound Healing Protocol to all surgical procedures. This cutting-edge approach

Encourages solid bone regeneration by leaving the grafted site partially open to heal with the body’s natural scaffolding.

• Helps stabilize the surrounding soft tissues for better long-term outcomes.
• Dramatically lowers the risk of cavitations and incomplete healing.

This isn’t just a new technique; it’s a new standard. This evolution in treatment reflects our commitment to helping our patients heal fully, naturally, and in a way that supports their long-term oral and systemic health.

Surgical Protocol

Atraumatic Tooth Removal

Extractions are done slowly and gently to protect the surrounding bone. Though this may slightly extend surgery time, it improves healing.

Thorough Site Debridement

We take time to carefully remove all soft tissue, sclerotic bone, and any areas of infection to create a clean, healthy foundation for healing. To support this, we use advanced tools such as piezoelectric ultrasonic instruments, dental lasers, and medical-grade ozone.

Sticky Bone Placement

We create a substance called “sticky bone” by combining your body’s natural healing cells (platelet-rich fibrin) with a biocompatible bone graft. This mixture forms a gel-like material that fills the socket and supports strong, natural bone growth. Our grafts are composed of purified minerals that are biocompatible, sterile, and free of unnecessary additives.

Site Closure

A non-resorbable membrane is placed directly over the grafted site and intentionally left partially exposed. This technique encourages the body to regenerate solid bone by giving it the space and protection it needs, something the body does not reliably achieve on its own without support. The membrane is safely removed three weeks after surgery.

Post-Surgical Protocol

Antibiotics

We understand concerns about antibiotic overuse. However, research has shown that extraction and grafting sites often harbor harmful bacteria, and a short, 3-day course of antibiotics significantly improves healing predictability and reduces the risk of post-surgical complications.

Pain Management

• Most patients do well with over-the-counter ibuprofen or Tylenol.
• For a natural approach, we offer the StellaLife recovery kit in our office.
• Clove oil and oil of oregano may also offer relief.

2-3 Weeks After Surgery: We’ll remove any sutures and the protective membrane (if placed).

 Your Healing, Guided by Science

At Rehme Dental Care, we strive to deliver the most advanced, science-based care possible. Our surgical protocol is grounded in cutting-edge biological techniques that give your body the best possibility to heal. By actively guiding your body’s natural ability to regenerate bone and tissue, we deliver more than a dental procedure; we provide confidence in your healing and a stronger foundation for lifelong health.