top of page

Clinical Notes

Extraction with Bone Grafting and Immediate Implant


Progress NOTE


Patient seen at the request of the office general dentist for evaluation of dental caries, and need for extractions, bone grafting and dental implants. Reviewed referral sheet with patient and identified the teeth to be extracted by marking x on printed xray sheet. Discussed in length various available option including but not limited to  Fixed bridge vs dental implants. After patient demonstrated complete understanding of the proposed options decided to proceed with procedure. Risks /Benefits / Complications discussed including all steps with patient from placement to final restoration. Risks, benefits, complications in particular to their case were also discussed.

Past Medical History
Refer to patient history form

Past Surgical History
Refer to patient history form

Refer to patient history form

Refer to patient history form

Social History
Smoking – Refer to patient history form
Alcohol - Refer to patient history form
Drugs - Refer to patient history form

Extraoral, Head and Neck exam: 

Constitutional: general appearance of patient  
No extraoral swelling or erythema 
Parotid and submandibular glands soft, nonpainful to palpation bilaterally 
No lesion noted on facial skin
Facial palpitation exam reviews no swelling or no lymphadenopathy 
CN V1, V2, V3, CN VII intact bilaterally 
No neck masses noted
Thyroid midline with no evidence of any swelling
Musculoskeletal: TMJ joint seems to be normal. No poping upon opening
Maximum mouth opening within normal range

Intraoral Soft Tissues: 

Clear saliva extruded from bilateral Wharton’s and Stenson’s ducts 
Tongue soft and non-tender with no apparent lesions 
Buccal mucosa without lesions bilaterally 
Hard palate, soft palate, and pharynx are within normal limits no pathology visualized 
Floor of mouth without an evidence of pathology


Refer to dental chart for detail dental caries evaluation

Radiographic examination: 
Panorex reviewed demonstrates
No bony pathology. 




Surgical # xxxx. Socket preservation, membrane and immediate implant placement

Discussed risk, benefits, complication of surgery including but not limited to bleeding swelling, infection, pain, retained root tip, numbness of lower lip, chin, tongue. Patient understood risks informed, verbalized understanding and consented accordingly.

Local Anesthesia
___ 2% lido w/ 1:100,000 epi Carpules (1.7 cc)
___ 4% sepocaine Carpules (1.7 cc)
___ 3% Carbocaine w/o epi Carpules (1.7 cc)

Procedure Performed
SURGEON 1:  Joseph Krajekian, D.M.D., M.D.

   Surgical # xxxx. Socket preservation, membrane, and immediate implant placement


After proper time for local anesthesia to work.
Mouth prop utilized, throat pack used followed by sweetheart.

After case was discuss with referring dentist.

Patient rinsed with peridex for 30 sec prior to starting procedure


Tooth was surgical extractions and in standard oral and maxillofacial surgery fashion with use 15 blade intra-sulcular incision, periosteol elevator to reflect full thickness mucoperiosteol flap, straight elevator,  drill used with copious irrigation to section the tooth if indicated. All attempts were made to preserve the buccal wall.  Tooth was then removed by elevators/crane picks and rongeur. Following extraction socket was aggressively curetted 


With use of sequential drilling sequence per Straumann guidelines 800/600 RPM with chilled saline. Started with pointed bur, followed by pilot at depth of 8mm. Intra-operative xray taken to review position. Appropriate corrections make and drill hole was extended to appropriate depth with accommodated the planted implant below. Multiple intra-operative xrays taken during every step in additional to a final placement xray.

after placement of implant at crest level, bone grafts placed between implant and socket walls followed by membrane, collaplug and closed with 3.0 vycril suture tention free.

Straumann SLA Tapered implant 4.1 x10mm was placed.

Quality of bone was :      __ D1    _X_D2   __D3   __ D4

Expected stage II : 4 months


Follow-up in _ 3-4__ weeks




Pen VK 500mg    PO q6 hrs Disp 7 days                     refill 0
Tylenol #3          1 tabs PO q6 hrs prn Disp 5 days    refill 0
Peridex                Provided from the office                  refill 0
Motrin 800mg      1 tablet every 8 hrs prn x 28 pills    refill 0


4 weeks with me if needed. Patient was provided post-op instruction/medication sheets in writing and they were also review with patient escort. Pt and escort were also provided with my 24 hour direct contact number and was also instructed to contact the office with any questions

DICTATED BY :                    
Dr. Joseph Krajekian DMD, MD            

bottom of page