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Lower extractions are very commonly done with Carbocaine alone. Virtually every individual with high blood pressure requiring a tooth extraction has the procedure performed with Carbocaine. It should pose no problem. Like yourself, I would be reluctant to undergo treatment with propofal. Additional Carbocaine can be administered as needed to extend the period of anesthesia.
Bone grafts are often best performed at the time of extraction. But they can generally be done later.
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