Dental Bone Grafting

A dental bone graft replaces lost bone in the jaw. Donor bone is transplanted into the area and acts as a framework for your remaining bone to grow around and over. This surgical procedure is often performed before dental implants are fitted or to save your teeth from falling out.  

This post starts by explaining what a bone graft is and how it works. We delve into the materials used and the different terms dentists use to describe the type of bone graft you’re having.  Then we discuss the procedure – what happens in surgery, how you can prepare and what happens afterwards. Basically, we cover everything you need to know about bone grafting in the jaw.

dental bone grafting

What Is Bone Grafting?

Dental bone grafting is a surgical procedure to reverse bone loss in the jaw. Missing bone can be replaced with natural bone transplanted from elsewhere in your body, a cadaver, or from a synthetic source.

The procedure is intended to improve the stability and support of the natural teeth and jaw and to help preserve or restore the function of the teeth. They are frequently performed prior to dental implants being fitted or to correct malformations. 

They are typically performed by oral surgeons or periodontists.

What Causes Bone Loss In The Jaw?

Bone loss can occur in the jaw following gum disease, tooth loss, cranioplasty, oral cancer, infection, congenital malformations or trauma. 

Find out more about preventing gum disease at home.

Why Does This Cause Bone Loss?

When a tooth is lost following extraction or periodontal disease, rapid bone loss occurs. The tooth root stimulates bone metabolism (bone cells are continually replaced – cells die and new ones grow – this is bone metabolism.) When the root is lost bone metabolism stops and cells are not replaced.

Periodontal disease, infection and trauma can lead to tooth loss, but also bone metabolism shifts so the balance is tipped. More cell death than renewal occurs. The jawbone shrinks. 

How Does Dental Bone Grafting Work?

If you’ve ever fractured (broken) a bone you’ll know that it healed and was as good as new afterwards. This is because, unlike other tissues in your body, bone can regenerate and repair itself – amazing stuff isn’t it?!

However, this can only happen when there’s a space for the bone to grow into. Your jawbone can’t simply regrow when lost. But if a space is created and protected your jaw bone can grow into it (this is called guided bone regeneration or GBR). 

When a big area needs to be replaced, scaffolding is needed for the jaw bone to grow on and around. The scaffolding is made out of transplanted donor bone. As bone cells are continually renewed, over time, the transplanted bone will be replaced by new bone. Transplanted bone will be fully integrated into the jaw.  (This is a bone graft!)

Why Might I Need A Bone Graft?

There are several reasons why a person might need a dental bone graft, including:

 

  • Dental implant surgery
  • Repair damage from periodontal disease, trauma or injury
  • Correction of congenital defects

 

How Common Are Dental Bone Grafts?

Dental bone grafting is extremely common, current statistics indicate that approximately 2.2 million procedures are being performed each year. It is thought that this figure will increase by around 13% annually [1]. 

Dental implants account for many of these. It has been estimated that up to 50% of all dental implant procedures currently performed will involve the use of bone grafts [2]

Where Is The Donor Bone From?

Bone graft material can be sourced from a number of places including 

  • You – when taken from your own body it is referred to as an autograft or autogenous bone graft. If a small area needs treating (a minor bone graft), bone can be taken from your jaw or chin. When a large area needs to be repaired (a major bone graft) bone tissue can be sourced from your hip, leg, iliac crest or even your skull. These major procedures would require a hospital stay. 
  • A cadaver – Bone material can be sourced from another human, often a cadaver and freeze-dried. This is an allogenic bone graft.
  • Another species – Bone is taken from another animal such as a cow. The bone is processed at very high temperatures to avoid the potential for immune rejection and contamination. A Xenogenic bone graft.
  • Synthetic materials – synthetic bone includes demineralized Bone Matrix (DBM)/Demineralized Freeze-Dried Bone Allograft (DFDBA), Graft composites and Bone Morphogenetic Proteins. An alloplastic bone graft. 

Which Material Is Best?

Each material has advantages and disadvantages. Autografts are seen as the gold standard as the risk of rejection is much lower however a second surgical site is needed. Synthetic, allogenic and xenogenic materials have the advantage of not requiring a second procedure to harvest bone, reducing risk and pain but they may be more likely to get rejected. 

What Types of Bone Graft Are There?

Bone grafts can be classified in a number of ways. The most common way to classify them is by the type of bone material being used (as above) is used.

They can also be classified according to the way bone is transplanted (block or particulate) or the place where the graft is taking place. Yes, it can be confusing. But don’t worry your oral surgeon or periodontist will explain it all to you. 

  • Block Graft – A large piece of bone is transplanted into the defect. Think brick-like in shape. 
  • Particulate – Tiny particles of bone are dropped into the space

 

  • Sinus Lift –  or sinus augmentation is a surgical procedure used to add bone to the upper jaw, particularly in the area of the molars and premolars.
  • Ridge Preservation  (ridge augmentation)is used to preserve the structure of the jaw bone after a tooth has been extracted. The bone material is dropped into the extraction socket immediately after the tooth is removed, this helps preserve the shape and volume of the jaw bone. 
  • Periodontal bone graft – this is performed to stabilise mobile teeth and provide additional support.
  • Staged Bone Graft – If the area to be restored is very large the procedure may need to be done in steps. A little bit of the area is being mended at a time. Until the whole area has been restored. 

You may also hear the terms osteogenic, osteoinductive or osteoconductive to describe the type of bone graft you’re having. These terms are less commonly used but are reflective of the way the bone cells grow and graft around the transplanted bone. 

What About Guided Bone Regeneration?

Guided bone regeneration is a method of making the bone grow into the space it is missing from. It can be used in combination with a bone graft or alone. 

It is a surgical technique used to promote the growth of new bone in areas where the jawbone has been damaged or lost. The procedure involves the use of a barrier membrane, which is placed over the area where the bone loss has occurred. The barrier membrane acts as a physical barrier, separating the wound from the surrounding tissue and allowing the patient’s own bone cells to migrate into the area and form new bone.

It is often performed when dental implants are being fitted when only a small amount of bone is missing.

The Bone Grafting Procedure

If you’re about to have surgery to restore your jaw bone here’s the answer to some of the questions you might have about the surgery. 

What Happens During Bone Grafting Surgery?

During a dental bone graft, the surgeon will make an incision in the gums to expose the jawbone. The bone material is then carefully placed in the area of the jaw where the bone is needed and secured in place with small screws or plates. The incision in the gums is closed with sutures.

How To Prepare For A Bone Graft?

Your surgeon will perform a complete medical history and physical examination before your surgery. You’ll be asked to stop smoking and eat a healthy diet before and after surgery. It’s a good idea to arrange transportation home as you won’t be able to drive straight away. It’s important to follow any instructions the surgeon gives you.

If you are having a major bone graft, ensure you chat to your surgeon for honest advice about how long your recovery period will be.

What Happens Afterwards?

Following surgery, you may experience some swelling and bruising. They are normal side effects that should diminish in a few days. Symptoms can be managed with pain relievers.

You will need to eat soft foods for a few days while the graft heals. 

The healing process can take several months, during which time your own bone will grow into the graft, creating a strong foundation for dental implants or other dental procedures.

It is essential to follow the instructions given by the surgeon to ensure proper healing and the best possible outcome. 

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Frequently Asked Questions

What Are The Advantages of Dental Bone Grafts?

There are several advantages to dental bone grafts. Dental bone grafts can help to preserve the integrity of the jawbone and prevent further bone loss following tooth loss or extraction. They also increase your eligibility for dental implants. A bone graft can also improve the appearance of your mouth and your oral health.

What Are the Risks Or Complications Of Dental Bone Grafts?

As with any surgical procedure, dental bone grafts carry a risk of complications. However, most patients experience no serious complications and are able to return to their normal activities within a few days. Some of the risks include infection, heavy bleeding, nerve damage, and complications from anaesthesia. 

Can Dental Bone Grafts Fail?

The success rate of bone grafts is very high but yes, dental bone grafts can fail in some cases.

How Painful Is A Dental Bone Graft?

Many patients experience minimal discomfort, while others may have more significant pain. The discomfort can vary depending on the specific type of graft being performed and the individual patient’s pain tolerance. 

Are You Put to Sleep For a Dental Bone Graft?

In most cases, the procedure does not require the patient to be put to sleep. A local anaesthetic is typically used to numb the area around the graft site, and the patient remains awake during the procedure. However, if you are having a major bone graft where the bone is taken from your hip a general anaesthetic may be used. 

What Alternatives To Bone Grafts

Are Available?

If bone grafting is required for the placement of dental implants but you want to avoid the procedure there are some alternatives. Options include zygomatic implants, bridges, dentures or doing nothing at all.

How Much Is A Bone Graft?

The cost of a dental bone graft can vary widely depending on a number of factors, such as the type of procedure, the experience and the location of the surgeon. On average, the cost of a bone graft can range from $1,000 to $4,000. However, in some cases, the cost can be as high as $10,000 or more. To get an estimate for bone grafting in your unique situation consult.

References

  1. Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments – PMC 
  2. Cha HS, Kim JW, Hwang JH, Ahn KM. Frequency of bone graft in implant surgery. Maxillofac Plast Reconstr Surg. 2016;38(1):19. Published 2016 Mar 31. doi:10.1186/s40902-016-0064–2 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819798/?report=reader