Bone grafting is conducted in over half of the patients that undergo implant placement. The surgery makes the whole process longer by a couple months. What’s more, grafting also notably raises the final cost. On the other hand, it greatly increases the success rate.
Together with our dentists we have prepared a complete overview about bone grafting. Find out whether you might need it and what you can expect during the procedure.Creative Commons
What is a dental bone graft?
A dental graft is a procedure that aims to increase the density and volume of the jawbone. It is necessary when the bone is too thin to support dentition or a restoration, typically an implant. This can happen because of bone loss. The main causes are:
- missing teeth,
- genetic or developmental defects,
- untreated periodontal disease, and
- a worn-down alveolar ridge (e.g. due to an ill-fitting denture).
Therefore it is typically recommended in three situations:
- directly after tooth extraction: to prevent the bone from being reabsorbed by the body
- in patients with untreated gum disease: to increase the chances of keeping loose teeth, and
- before dental implantation: to prepare a stable base for tooth restoration.
Is bone graft for dental implants necessary?
Bone grafting before dental implantation is not always compulsory. It is necessary in the presence of bone loss. Nonetheless, studies show that more than half of implant placement procedures are preceded by grafting.
At least 1 mm of bone is required for safe implantation. Even more might be needed when the post is to be placed next to a tooth or another implant.
Bone grafting can be conducted just before implant placement, sometimes on the same day. Most often, however, it is recommended that you leave 4-6 months between the surgical procedures.
This allows the material to integrate with the bone for a stable base. Unfortunately, grafting makes the implant process a few months longer.
Additionally, the bone grafting procedure significantly increases the total cost of tooth restoration with an implant, even by $600.
What material are dental bone grafts made of?
There are four types of grafting materials:
- autograft: from the patient’s own body, the most popular places are from the chin or leg,
- allograft: from a human donor, often from a licensed bone and tissue bank,
- xenograft: from animal bone, usually from horses,
- alloplast: from a non-biological material, typically a form of metal or plastic.
Which is ultimately chosen is decided by the dentist performing the procedure. It depends on the situation in your mouth as well as on what resources are available.
Dental bone grafting step-by-step
The dental bone grafting procedure can be split up into five stages.
The first step is always a thorough medical history check and composition of a treatment plan. You and your dentist will discuss what material is to be used for the graft. Then, it’s time for action.
You might have anesthesia administered before your primary procedure. A local injection or IV sedation are most commonly used. In case of dental anxiety, you may have to be completely put under.
It is likely that you will have to fast for some time before, especially if a deeper type of anesthetic is used. This can help prevent complications.
Extraction and/or bone sourcing
Your dentist will first source the bone if it is determined that it should come from your body. The graft itself should not cause any more discomfort than pulling a tooth.
The tooth is then removed, providing an extraction was scheduled.
An anesthesiologist will monitor your vital signs during the operation if you go with general anesthesia. Before placing the bone, the area will be thoroughly cleaned.
The insertion itself is a short, simple procedure. Your surgeon will make an incision if there was no extraction. He or she will then insert the grafting material into the area.
When the grafted bone is in place, the surgeon will stitch up the wound and possibly apply a bandage. The hole will be closed up with pins, plates, wires, or cables. Sometimes a titanium screw or splint is necessary to hold the tissue together.
If the bone was sourced from your body, that area will be sewn back together as well.
What does recovery after a dental bone graft look like?
Dental bone grafting recovery is mild. You are likely to be able to return home the same day. Somebody might have to drive you, depending on whether you had general anesthesia.
Overall, you will need about 4-6 months of healing in total. The grafting material and the jaw need time to merge and grow. This period might be even longer, especially if you have a history of substance addictions or an oral condition. It also depends on the site of bone sourcing, if it came from your body.
Dr. Richard Hattaway
Autografts from the chin can be a very uncomfortable recovery.
It is vital to adhere closely to your dentist’s instructions at this time in order to prevent failure or complications. Symptoms that might cause discomfort, but are perfectly normal include:
- gum or skin swelling,
- draining from the surgical site,
- slight bruising,
- minor bleeding,
- nausea from anesthesia,
- pain in the affected area.
Use a cold compress and OTC painkillers to manage these issues. Your dentist might also prescribe a blood thinner. This can prevent blood clots in the surgical site as well as source of the bone used for grafting.
Dental bone graft aftercare also includes consuming mainly soft foods while the mouth heals. Food high in calcium and vitamin D can help speed up recovery. Avoid smoking, excessive drinking, and mouthwash that contains alcohol.
After a few days or even weeks you can expect a follow-up visit, one that often includes X-rays. Those can confirm that your surgery was successful. You might also get stitches or staples removed at this time.
Signs of failed dental bone graft
A bone graft is considered failed if the material falls out due to a loose tooth or receded gums. You might feel some granules in your mouth for a few days after your surgery. This is not a cause for concern if it doesn’t happen consistently.
Failure of a bone graft is relatively rare as it is a low-risk procedure. Nonetheless, some complications are possible. Smokers, elders, patients with chronic medical conditions, and those who chose an allograft are at particular risk.
The most common side-effects are:
- heavy bleeding,
- blood clotting,
- nerve damage,
- gum recession, and
- anesthesia-related complications.
If draining, swelling, bleeding, or pain last longer than a week, schedule a consultation. You will probably have an X-ray that can confirm that everything is as it should be.
Is bone grafting painful?
You probably won’t feel much discomfort after the procedure except a little soreness in the gums. Dentists often compare the recovery to what you feel like after a tooth extraction.
No doctor will perform a bone grafting without proper sedation, however. Sometimes a local injection or laughing gas are enough. If you suffer from dental anxiety, you might have a stronger form of anesthesia.
How long does a dental bone graft procedure take?
Including the extraction, the whole procedure can take as little as 45 minutes. It might last longer if you go with a more complex type of anesthesia.
Can you get dental implants with bone loss?
Yes, it is possible. But in this case bone grafting is necessary to increase bone volume. This creates a stable base for the implant. If your jaw is too thin or brittle, your implant is more likely to fail. The dentist will make the final decision about whether you are a candidate.