Dental implants have revolutionised modern dentistry. They offer an effective way to replace teeth lost to infection, trauma, severe tooth decay, or gum disease. Unlike high-maintenance bridges or dentures, implants are fixed directly to the jawbone, so are a long-lasting almost permanent solution. Implants also retard bone loss (by absorbing bite force stresses), and create a stronger bite that allows you to eat the foods you love, look completely natural and are comfortable!
Occasionally, especially when teeth are lost and not replaced for some time, the missing bone (where the tooth once was) needs building up in order to support an implant. This bone build up is referred to as a bone graft. But when exactly are bone grafts necessary for dental implants?
What is a bone graft for dental implants?
A bone graft is a surgical procedure (that is routinely performed by Specialist Surgeons) to replace and regenerate jaw bone volume, so that dental implants can be placed successfully. If there’s not enough bone, the dental implant cannot attach to the jaw and will either fail or not last as long as it should. You will need bone grafting if the jaw is too thin (narrow), short (height) or is insufficient around important vital structures (like nerves or sinus cavities), so as to create a solid foundation for your new dental implant.
The placement of dental implants is a routine event for Specialist Surgeons in the field. However, there are many Dentists who will either fail to recognise the need for bone grafting or will be unable to offer the complete treatment needed to ensure successful implant treatment. A Specialist Surgeon has the added training and experience to properly consider the condition of your jaw bones and undertake the necessary treatment in a skilled minimally invasive manner. A bone graft can stabilise tissue, add bone mass to your jaw, and enable the implant to sit more securely in your jawbone. If your jawbone has thinned, weakened or deteriorated, the implant will be at increased risk of failing under the pressure exerted from repeated chewing.
A bone graft for dental implants could be pieces of your own bone (which will often come from your chin, the back of your lower jaw, or your shin or hip). If there is insufficient bone in these areas, animal (cow or pig) or freeze-dried human bone may be used. Synthetic bone graft materials are also often used, meaning that rejection risks are lower; these materials will also be of interest to vegans and patients with religious beliefs excluding the use of animal by-products.
Do I need a bone graft for my dental implant?
Unfortunately, bone resorption (the thinning, weakening and deterioration of the bone) is a common side effect of tooth loss and can affect patients of all ages. Before your Specialist Surgeon can make a recommendation regarding dental implants, a thorough evaluation of the volume of your jaw bone is made using X-rays and computed tomography (CT) scans. (The cost of CT scans and X-rays are completely covered by Medicare when requested by Specialist Surgeons).
The data obtained in the CT scans is analysed using 3-dimensional software that allows a computer-based virtual surgical procedure to be undertaken, without ever having touched the patient. This analysis becomes a complete surgical plan, detailing any potential hazards, and selecting the most ideal implant sizes, sites and angulations, avoiding nerves and sinus cavities, and enables the creation of surgical guides for accurate implant placement.
The surgical plan then becomes the basis for accurate treatment quotations, and most importantly reduced operating time, fewer complications and a faster recovery for the patient.
These are two common scenarios that may require bone grafting:
Replacing one or two teeth with implants
Most commonly, one or two teeth are being replaced with implants. In this situation the treatment stages are:
- Tooth removal + immediate implant placement + bone grafting – The bone graft volume is small and the space around the implant (where the tooth root once was) is filled with sterile, synthetic or demineralised human bone granules, then covered with a protective collagen membrane and stitched together. Over the next few months, the bone graft will heal and integrate with the surrounding bone tissue, preserving the bone height enough to support the dental implant. To ensure the best result, many Specialist Surgeons will use a platelet-rich blood product (Platelet-Rich Fibrin / Platelet-Rich Plasma) to mix with the bone graft, thus reducing the risk of wound infection and speeding the healing process.
- Implant integration testing – 3 months after implant placement.
- Implant crown (tooth portion) placement – 1 month after implant testing.
Replacing multiple missing teeth with implants
Patients who have had multiple missing teeth for a longer period of time (many years) often experience advanced bone loss. In this case, extensive bone grafting may be necessary to restore the bone. Specialist Surgeons have developed skills to enable the placement of blocks of bone graft material (often fixed in place with plates and screws) to reconstruct large bone defects. Typically the bone graft will be a combination of products each of different consistency- autologous (from the patient’s jaws, hard palate or hip), combined with human origin (cadaveric) and synthetic products to completely fill in any gaps.
Finally, your Specialist Surgeon will put a layer of collagen membranes and PRF / PRP to cover the bone graft material, before closing the wound over using stitches. After 3-4 months of healing, the bone graft is healed enough to allow placement of implants.
What is involved in the bone graft procedure?
A typical procedure involves removal of a tooth, implant placement and bone grafting in a single stage. Thus, shortening the overall treatment time and requiring a single recovery stage (rather than 2-3 episodes of recovery).
The procedure is performed either awake (under local anaesthetic) or asleep (day stay procedure in Hospital). Recovery time is usually 1-2 days.
A 3D X-ray (CT, Cone Beam – Medicare rebated) image will be taken of your jaws, which will allow for customised planning (and costing) of the suggested procedures. Your Specialist Surgeon will remove the tooth (in multiple pieces to minimise bone loss and shorten the recovery), then thoroughly clean the bony socket, then place the implant directly into the tooth socket. Bone graft is then applied around the implant to fill in the gaps (between the tooth socket and the threads of the implant) to ensure the bone fuses with the
A typical procedure can be performed in a dental surgery or as an outpatient. Before surgery, a 3D X-ray image will be taken of your jawbone, and a local anaesthetic or IV sedation administered to prevent any discomfort. If there is enough bone present to insert the implant but not enough to cover its sides, a small grafting procedure will be undertaken. Your surgeon will thoroughly clean the area and then make an incision through the gum tissue to expose the area requiring the bone graft.
If you are receiving bone from your own body, your surgeon will make a second incision to harvest the healthy bone tissue, and if not, they will source bone tissue externally. It is then placed between the two sections of bone that need to fuse. Your surgeon may make repairs to the surrounding tissue, and the incision site is then closed. For extensive cases (where large changes must be made to the implant area’s size and shape), additional surgery may be required before the implant is inserted several months later.
Grafted bone usually takes around six months to fuse with existing bone, but it has a high success rate as bones aren’t rejected by the body, as with organs.
What are the different types of bone graft?
This is the most common type of bone graft for a dental implant. Its purpose is to protect the alveolar bone and prevent its deterioration. The procedure places new bone directly in the socket where the tooth has been removed. It stabilises the socket as the area heals and provides a firm base for the dental implant.
Block bone graft
The jaw can have defects if it has been subject to a significant injury from an accident or other trauma. In this case, your surgeon will remove a large “block” of bone from the back of your jaw and hold it in place with titanium screws until it bonds with the surrounding bone tissue. Once the tissue and gums heal, dental implants can then be inserted.
Lateral ridge preservation graft
If a patient’s jaw is not wide enough to hold dental implants, human bone may be used to increase the jaw’s width and enable the implant process to continue.
Sinus lift procedure
The upper jaw is typically not stable enough to hold a dental implant on its own. In this case, equine bones (which are similar to human bones) may be used to build a base for dental implants. They promote bone growth in the sinus area and create added support for the sinus cavity.
How much does a bone graft cost?
The cost for an implant procedure can differ significantly between patients, depending on their circumstances. However, a single, straightforward dental implant typically costs between $3000 and $7000. The cost increases if you need a bone graft, multiple implants or a sinus lift. Australian health insurance policies typically don’t include the cost of implants or bone grafts unless you have a high level of “extras” cover.
What is the best bone graft material for dental implants?
The best bone graft material is your own bone – also called an autograft (bone taken from your own body). This kind of graft is most often sourced from your own jaw bone during the stage 1 implant procedure (removal of the tooth and placement of the implant). In this way, there is no need for a separate wound (to collect bone from sites outside the mouth), and therefore the healing is much quicker.
Other forms of bone graft material are synthetic (manufactured bone granules and blocks), cow (bovine) bone and human (cadaveric) origin bone.
The choice of bone graft depends on the amount needed and sometimes a mixture of bone graft material is used.
Dental bone graft recovery
After bone graft surgery, you will experience minor to moderate discomfort, including possible bleeding, bruising, and swelling of your gums. For most patients, the pain from bone grafting is limited to 24-48 hours after the procedure.
Things to do during recovery from dental implant and bone grafting procedures include:
- Pain and swelling relief: Your surgeon will prescribe anti-inflammatories prior to the treatment, which can be continued after treatment, as needed.
- Oral care: Use a small, soft bristled tooth brush, don’t floss around the implant, and rinse with non-alcoholic mouthwash 2-3 times a day, post meals. To avoid irritation, make sure to brush gently and carefully around the surgical site.
- Eating: Only consume soft foods and try to keep the food away from the surgical site for 3-4 days. Avoid hard, spicy and crunchy foods for the first few weeks and reintroduce these foods slowly.
- Check-in with your Specialist Surgeon: Review appointments are scheduled for 2 weeks and 3 months post stage 1 implant treatment. If you feel that something isn’t progressing as it should, then arrange a review appointment as soon as possible to ensure your implant is healing properly.
Dental bone graft risks
Bone grafting for dental implant treatment is safe and typically has a very high success rate. However, as with all surgical procedures, there is a small risk of:
- Allergic reaction
- Rejection of the grafting material
- Wound breakdown
- Nerve damage
- Damage to natural teeth or blood vessels
- Excessive bleeding
- Numbness, tingling in gums, lips, and cheek
- Sinus problems (with upper jaw implants)
- Swelling, pain and bruising
- Abnormal bone development
- Blood clots
If any of these signs concern you or seem excessive, contact your dental surgeon for advice. Selecting a well-experienced and reputable Specialist Surgeon should reduce your risk of complications and poor outcomes.
- 2019, Bone graft for dental implant – is it really needed? Dapto dentists
- 2020, Bone grafting, National Dental Care
- 2020, Dental implant guide: cost, process, risks and more, Smile.com.au