Visit 1 - Screening visit After reading and signing this informed consent form, you will complete a detailed medical and dental history form. We will review this form with you to ensure you can safely participate in the study. You will also have an oral exam to determine if you qualify for the study. If you are a woman of childbearing age, you will be tested for pregnancy. If you are pregnant or trying to become pregnant, you cannot participate in the study. You will also have one digital dental x-ray of the area for tooth extraction, if not available already, which is standard of care. You will also have dental impressions (molds of your teeth), which are made in a non-invasive manner to collect data for some of the research measurements. This visit will last between 1 and 1.5 hours.

Visit 2 - Baseline visit In less than 10 weeks after the screening visit, you will have the tooth extraction and bone grafting, which will be just like the procedure performed for patients who are not enrolled in the study and present a similar clinical scenario. Before the surgical procedure, a special dental x-ray scan known as cone beam computed tomography (CBCT) will be taken for the purpose of collecting research measurements. The CBCT scan generates 3D images of your teeth and surrounding tissues. After numbing the area, clinical measurements will be gathered. These measurements are non-invasive (do not involve cutting your body or putting instruments inside it) and will not harm the gums or surrounding teeth. The extraction (removal of the tooth) will be performed and the tooth socket (the area surrounding the tooth that was removed) will be cleaned, which is what would happen to patients who are not enrolled in the study. At this time, additional measurements of the area will be taken. These measurements will not cause you any extra discomfort, since that area will be numbed. Then, the socket grafting technique will be performed. The treatment will consist on the combination of a bone grafting material from a human donor (EnCore, Osteogenics Biomedical Inc.) and a non-dissolvable barrier membrane (Cytoplast TXT-200, Osteogenics Biomedical Inc.), to protect the bone graft and that will be removed in 5 weeks. You will be given prescriptions for an antibiotic, a pain reliever and a mouth rinse. You will also receive home care instructions before you leave. This visit will last about between 1.5 to 2 hours.

Visits 3, 4, 5 and 6 - Post-operative follow up visits You will return to the clinic at 1, 2, 5 and 20 weeks, which is standard of care in many cases of tooth extraction and grafting. In these visits, you will have an oral exam, check-up, and the researchers will monitor how well you are healing. These visits will last approximately 30 minutes.

At the 5-week visit, the barrier membrane will be removed. You will not have to be numbed for this.

Additionally, only at the 20-week visit after tooth extraction, a second CBCT x-ray scan will be obtained to determine how much bone is available after the healing period to plan the implant placement and for research measurements. The second CBCT x-ray scan will allow your surgical doctor to evaluate the amount of bone volume and is standard of care when planning for dental implant placement. A dental impression (mold) will be made to collect information about the gum tissue. Recommendations on further treatment, including the potential for implant therapy or possible additional grafting, will be provided based on the findings from this visit.

Visit 7 - Implant placement visit If you can receive the implant, a surgical placement visit will be scheduled at approximately 24 weeks after tooth extraction. After numbing the area, a small gum flap will be opened to access the area underneath that was bone grafted. A bone sample biopsy will be taken and analyzed for research purposes. This bone would be disposed otherwise, since a bed must be created in the bone to allow for implant placement. After an adequate space for implant placement is created in your bone, the implant will be placed. If implant primary stability (sufficient retention) is not achieved, the doctor may need to place a larger implant (in length, diameter or both) or, if this is not possible, discontinue the procedure and plan for delayed implant placement at another time. If this is the case, the study will cover the costs associated with additional grafting and implant placement. Upon implant placement, your gums will be stitched and you will be given prescriptions for an antibiotic, a pain reliever and a mouth rinse. You will also receive home care instructions before you leave. This visit will last between 1.5 and 2 hours.

Visit 8 - Post-operative follow up visit You will be seen by your surgical doctor for a postoperative visit at approximately 2 weeks after the implant is placed to monitor the healing and to remove sutures, which is standard of care. You will have an oral exam, check-up, and the researchers will monitor how well you are healing. These visits will last approximately 30 minutes. This is the last visit of the study.