Socket Preservation
in Honolulu, HI
 Socket preservation is a small bone graft placed into the socket of a tooth immediately after extraction, with the purpose of preventing bone loss in the jaw before a future dental implant.
At Pacific Maxillofacial Center, our board-certified oral and maxillofacial surgeons place socket preservation grafts at our Honolulu and Waipi’o offices, most often during the same appointment as the extraction itself.
The procedure is a specific subset of bone grafting focused on the extraction-day decision. If you have already lost a tooth and your jaw has been healing without a graft for months, the relevant next step is usually a different procedure such as ridge augmentation or a sinus lift, depending on where the bone needs to be rebuilt. This page covers the same-visit graft option for patients who are planning dental implants after an upcoming extraction.
On This Page
What Is Socket Preservation?
 When a tooth is removed, the empty socket starts to remodel almost immediately. The body resorbs the bone that previously supported the tooth root, and the alveolar ridge in that area gets narrower and shorter over time. Most of that loss happens in the first 6 to 12 months after extraction. Published research generally puts the range at 40 to 60 percent of bone width loss in the first year if nothing is done to prevent it.
Socket preservation interrupts that process. After we extract the tooth, we place a bone graft material into the socket. The graft acts as a scaffold that your own bone grows into over the following months, maintaining the volume and shape of the ridge. A small protective membrane sometimes covers the graft to keep soft tissue from filling the space.
The result is a healed site with enough bone to support a future dental implant without needing a larger graft procedure later.
When Socket Preservation Makes Sense
Socket preservation is not appropriate for every extraction. The decision usually comes down to two questions: are you planning to replace the tooth with a dental implant, and where is the tooth located?
If a dental implant is part of your treatment plan, socket preservation usually makes the implant phase easier. Without a graft, the bone loss often requires a separate, more involved graft procedure later if it goes unchecked. Placing a small graft at the time of extraction prevents most of that loss.
If you are not planning a dental implant, socket preservation is usually not necessary. Bone loss after extraction is a structural concern primarily because it affects implant candidacy. If there is no implant in the plan, the bone is allowed to remodel naturally.
Front teeth are a special case. The appearance of an anterior implant depends heavily on the gum and bone contour preserved during extraction. Socket preservation at front-tooth sites is commonly recommended for that reason, even when the implant is years away.
Your Oral Surgery Team in Honolulu
Pacific Maxillofacial Center was founded in 1999 by Dr. Todd K. Haruki, who completed 12 years of graduate and post-graduate surgical training, including a hospital-based oral and maxillofacial surgery residency at the University of Louisville. He is a Diplomate of the American Board of Oral and Maxillofacial Surgery and a Fellow of the American Dental Society of Anesthesiology.
Dr. Neil Oishi holds DDS and MD degrees from the University of Southern California and the University of Florida College of Medicine respectively, and completed his oral and maxillofacial surgery residency at the University of Florida. He is also a Diplomate of the American Board of Oral and Maxillofacial Surgery, a Member of the International Team of Implantology, and serves as an on-call facial trauma surgeon at Queen’s Medical Center.
The dual DDS-MD training matters for socket preservation specifically because successful grafts require careful soft tissue handling, attention to whether the socket walls are intact, and judgment about whether the case needs more than basic preservation. Both Dr. Haruki and Dr. Oishi place socket grafts regularly, often during the same appointment as the extraction, which keeps the surgical and grafting plan with the same hands.
The Socket Preservation Procedure, Step by Step
 Most socket preservation cases follow a predictable sequence, though the details vary with the tooth location and the condition of the surrounding bone.
Step 1: Extraction-Day Planning
The decision about socket preservation is best made before the extraction, not after. At your consultation, we review your CBCT imaging, evaluate the socket walls, and discuss whether a future implant is in your plan. If yes, we plan to place the graft during the same appointment as the extraction.
Step 2: Graft Placement
After we extract the tooth, we clean and prepare the socket for the graft. We place a bone graft material, choosing from several types including processed donor bone, animal-derived material, and synthetic alternatives. All of them serve as a scaffold for your own bone to grow into. We sometimes cover the graft with a small protective membrane, then close the area with sutures.
Step 3: Healing Period
The graft integrates with your existing bone over 3 to 6 months. During this period, you cannot have an implant placed. Your body needs time to remodel the graft into the dense bone required to anchor an implant. CBCT imaging at the end of the healing period confirms the bone volume before we move to the implant phase.
Step 4: Implant Placement
Once your bone is ready, the next step is dental implant placement following our standard protocol. The implant goes into the preserved socket site, and from there, the treatment timeline matches a typical implant case rather than a staged graft-then-implant case.
Benefits of Socket Preservation
For most cases where a dental implant is planned, socket preservation pays off across several dimensions of the eventual implant procedure.
The most concrete benefit is avoiding a larger graft procedure later. Without socket preservation, the bone in your extraction site resorbs predictably, and the implant phase may then require a separate ridge augmentation to rebuild what was lost. Because we plan the extraction, the graft, and the implant phase together at the initial consultation using CBCT imaging, we identify which sites will benefit most from preservation before the extraction is scheduled.
Single-visit timing is the practical benefit on procedure day. We combine extraction and graft placement into one appointment under the same sedation, which eliminates a second round of numbing and recovery. Our Honolulu and Waipi’o offices both have in-office anesthesia available, so the sedation plan does not change when the graft is added to the extraction visit.
Continuity of care matters for the implant phase that follows. Because our office handles the extraction, the graft, and the eventual implant, the surgeon who placed your graft is the same surgeon reading your healing imaging and placing your implant. The CBCT scan from your initial extraction visit stays in our system to inform the implant planning months later.
At front-tooth sites, aesthetic preservation is the additional reason to graft. Without socket preservation, the gum tissue collapses inward over the missing tooth, creating a visible dip in the gumline. Our standard approach at anterior sites is to plan socket preservation in the consultation, before the extraction is scheduled, because correcting that contour later is more difficult than preserving it at the time of extraction.
Why Choose Our Practice for Socket Preservation
Our two-office structure on Oahu means patients in Honolulu and the West Oahu corridor can both reach a board-certified oral surgeon without a long drive. The Honolulu office is at 1060 Young St #312, and the Waipi’o office is at 94-1221 Ka Uka Blvd #B-204 in Waipahu.
CBCT imaging from our dental technology stack does double duty for socket preservation cases. At the extraction visit, the scan shows whether the socket walls are intact enough for straightforward preservation or whether the case requires a larger graft. At the end of healing, the same imaging confirms the bone volume before we stage implant placement.
Performing the extraction, graft placement, and implant phase all under the same roof keeps the entire treatment with one team. There is no handoff between a general dentist who extracts the tooth and a specialist who places the graft, and no separate appointment to coordinate. Dr. Oishi’s membership in the International Team of Implantology brings additional implant-focused training to the planning phase.
Dr. Haruki’s ADSA Fellowship and both surgeons’ MD-level training mean the extraction-plus-graft visit can use whichever sedation level fits the case, from local anesthesia for a single tooth to IV sedation or general anesthesia for more complex situations.
Socket Preservation Cost and Insurance
Cost matters, and socket preservation is one of the procedures where the math often works in your favor. The graft itself is a relatively small additional fee on top of the extraction. Compared to the cost of ridge augmentation or other grafting procedures that may be needed later without socket preservation, the same-visit graft is usually the more economical option.
Dental insurance coverage varies. Some plans cover socket preservation when it is documented as part of an implant treatment plan; others classify it as a separate elective procedure. The breakdown depends on your specific plan and the diagnosis codes submitted. Our front office staff verifies benefits before treatment, and our insurance and financing section covers payment options for any remaining patient responsibility.
Call our Honolulu office at 808-585-8455 if you want benefits checked before scheduling.
Schedule Your Consultation
Socket preservation is best decided before the extraction. If a dental implant is in your plan, raise the question with us early. Call our Honolulu office at 808-585-8455 or request an appointment online. Our Honolulu office is at 1060 Young St #312, Honolulu, HI 96814. We also see patients at our Waipi’o office. The Contact page is the easiest way to reach us in writing.
Frequently Asked Questions
What is socket preservation in plain terms?
It is a small bone graft placed into the empty socket of a tooth right after extraction, most often during the same appointment as the extraction itself. The purpose is to keep the jaw bone in that area from shrinking before a future dental implant is placed.
Do I really need socket preservation?
The need depends on your treatment plan. If you are planning a future dental implant in that location, socket preservation usually makes the implant easier and reduces the likelihood of needing a larger graft later. If you are not planning an implant, the procedure is generally not necessary. The CBCT imaging at your consultation gives us the information to make this recommendation case by case.
Is the graft procedure painful?
The graft itself is placed while the area is already numb from the extraction, so you do not feel additional pain from the graft placement. Post-op discomfort is similar to a routine extraction and usually responds to over-the-counter pain medication for 24 to 48 hours.
What graft material is used?
Several materials work well for socket preservation, including processed donor bone (allograft), animal-derived material (xenograft), and synthetic alternatives (alloplast). The choice depends on the specific case, the surgeon’s preference, and the structural needs of the site. We discuss the material being used as part of the consent process before the procedure.
How long until I can get my implant?
The graft typically integrates over 3 to 6 months. CBCT imaging at the end of the healing period confirms the bone volume before we move to implant placement. Some cases heal at the shorter end of that range; complex extractions or larger defects may take the full 6 months.
Will I still need a bigger bone graft later?
In most cases, no. Socket preservation is designed to maintain enough bone volume that a future implant can be placed without additional grafting. There are exceptions: if the bone walls of the socket were compromised before extraction, a separate bone graft may still be needed.
Does insurance cover socket preservation?
Coverage varies by plan. Some dental plans cover socket preservation when documented as part of an implant treatment plan; others classify it as a separate elective procedure. Medical insurance generally does not contribute to socket preservation costs. Our front office staff verifies your specific dental benefits before treatment so you have a clear estimate.
What happens if I skip socket preservation and decide to get an implant later?
You can still get an implant later, but the path is usually more involved. After natural bone loss, you may need ridge augmentation to rebuild the bone before the dental implant can be placed. That adds 4 to 9 months to your timeline and is typically a more extensive surgery than the same-visit graft at extraction. |
