Dear Jeremy,
I'll qualify my answer by mentioning that I am not an oral surgeon, and I do not as a matter of general policy perform extractions on impacted wisdom teeth. However, I do have the perspective of observing the postoperative course of many patients who have had impacted wisdom teeth extracted by oral surgeons. The recent popularity of bone grafting is something whose justification escape me, and about which I am quite dubious. Being cynical, I can well understand the advantage of bone grafting for the oral surgeon, who for almost no additional effort, can add on a lucrative additional service to the patient's tab. However, impacted wisdom teeth have been extracted for ages prior to the advent of this new pseudo-"standard of care", with very few cases where the patient suffered from missing out on a bone graft.
Don't get me wrong-- some oral surgeons may truly believe that placement of a bone graft in a wisdom tooth socket will restore lost bone on the back-side of the adjacent second molar, and it makes intuitive sense. If you look at your x-rays, you'll see that those impacted wisdom teeth are in contact with the roots of those second molars, and have prevented bone from growing against their rear ends. It seems so logical to fill the void created by those newly-vacated bone cavities with bone, that it is too easy not to ask the question of whether a graft makes a difference. However, as a general dentist, I have an advantage over an oral surgeon, whose relationship with you will end as soon as your stitches have been removed. You see, I have the opportunity to see how my patients fare over the months and years after their wisdom tooth extractions, and I can happily report that almost all of them will develop new bone around their second molars, regardless of whether a bone graft is placed. Although I will concede that some situations (for example, where there is extensive cavitation of bone around a wisdom tooth as a result of the presence of a cyst) might benefit from bone grafting, the majority of cases will not. I would advise you to get a second opinion, if you wish, but I would decline the grafts if I were you.
By the way, the national average fee for a bone graft, according to a recent fee survey, is $474.10 each quadrant. I hasten to emphasize that this is the national average fee, but given the circumstances, it may not be appropriate to characterize it as a
fair fee. See code D4263,
http://downloads.pennnet.com/web_dl/121.pdf.
Hope this helps...
