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Bone Graft

What is a dental implant and bone graft?

In order for the dental implant process to be successful, there must be enough bone in the jawbone to support the dental implants. In cases where the bone under the gum is not wide, tall or dense enough, a bone graft is performed to create a strong foundation of bone for the implant to anchor into.
Bone loss can be caused by trauma, an abscess/infection and periodontal disease. In addition, the density of bone beneath missing teeth deteriorates over time. Patients who have been missing teeth for months or years often require bone grafts before they can get implants.

What are the benefits – why should I have a bone graft and dental implants?

Dental implants can be very useful where we would otherwise have to crown (cap) healthy teeth or where a denture or bridge would be difficult or sometimes impossible because there are no suitable teeth or gums for support. If there is not enough bone in your jaw, bone grafts may be required to insert enough implants to support dentures, crowns (caps) or bridges. Bone grafts may also be needed to improve the bone and gum at a proposed implant site so that it looks better. Rebuilding a site to its dimensions before tooth loss can be difficult and a compromise end result may have to be accepted.
Bones grafts range in complexity from supplementing the bone beside one implant to making significant changes to the shape and size of the dental ridge.
Small grafts can be performed by a dentist during implant surgery or extraction, while extensive bone graft procedures are usually performed by a dentist with advanced training such as an oral surgeon, prosthodontist, periodontist, implantologist, the graft takes several months to heal and mature before the implant is then placed.

 

When a small amount of bone is needed, we can transfer bone from one part of the jaw to the other. The bone graft is normally taken from the back of the jaw or from the chin area. This can be done under local anaesthesia (an injection which makes the area where we are working numb) and with or without sedation (to relax you).
* The gum is lifted away from the underlying bone where the graft is to be placed and the amount of bone needed is assessed.
* The bone is then taken from another part of your jaw after lifting the overlying gum and carefully drilling into the bone.
* The dentist will place the bone to be grafted onto the recipient site.
* The graft may be fixed in position with small pins or screws that can be removed when the implants are placed.
* The gum is replaced and stitched carefully back into place.
* The surgery usually takes about 60-90 minutes.
* The stitches are removed about a week later. Once the graft has been confirmed as successful, and the site of the bone graft is totally healed, the next stage of the dental implant process can begin. See our information sheet on dental implants for more information on this stage of your treatment. 


Your Own Bone
This is the safest and most effective because it integrates very well and there is no risk of infectious disease, contamination or tissue rejection. The bone is typically harvested in your own mouth (from the chin or jaw). Disadvantages of this source are that it requires two surgical sites, is more expensive and the is a limited supply unless more invasive techniqoues are used.

Human Cadaver Bone (Same species)
Freeze-dried and sterile, donor cadaver bone obtained from a reputable tissue bank is more affordable and generally quite safe, although it does carry some risk. Using human bone carries a similar level of risk of transmitting infectious disease to receiving blood from the blood bank.

Animal Bone
Cow bone has been commonly used for many years. It is sterilized and processed to minimize infection, but like human cadaver bone, there is the possibility of contamination. This graft material is naturally absorbed by the body and replaced with real bone over time.

Mineral Bone Substitute (Synthetic/ Laboratory bio-engineered)
Although less-effective than the other options, these sterile bone-like materials are second only to a patient’s own bone in terms of safety. This material is also absorbed and replaced over time.

Please note that some types work best in some clinical cases but not all, therefore your dentist may use a combination of sources to acheive the best result.

* Pain, swelling and bruising in the area where the graft (bone) has been taken from.
* Swelling in the jaw at the site of the graft which normally lasts for about one to two weeks.
* Infection and/or failure of the graft. We try to avoid this by using careful techniques and antibiotics.
* Insufficient successful graft bone to accept implants. In these cases further grafting may be necessary.
* The risk of failure is higher in certain individuals, particularly those who smoke, and you will be advised if we think risk of failure is higher than normal in your case.
* There is a higher risk of failure in implants placed into grafted bone rather than natural bone. 



Synthetic bone substitutes, or bone from animals or other humans, are available but do not perform as well as your natural bone. This is because it is less likely that your body will reject your own bone. On some occasions your bone graft may also be mixed with a synthetic material or bone from another source i.e animal derived products. In some cases a synthetic membrane may also be used to cover and protect the graft. We will inform you of any proposed synthetic graft or membrane, the composition of the graft/membrane and the origin of the graft/membrane (make/type). The choice of material can be discussed.

How is a Bone graft performed?

When a small amount of bone is needed, we can transfer bone from one part of the jaw to the other. The bone graft is normally taken from the back of the jaw or from the chin area. This can be done under local anaesthesia (an injection which makes the area where we are working numb) and with or without sedation (to relax you).
* The gum is lifted away from the underlying bone where the graft is to be placed and the amount of bone needed is assessed.
* The bone is then taken from another part of your jaw after lifting the overlying gum and carefully drilling into the bone.
* The dentist will place the bone to be grafted onto the recipient site.
* The graft may be fixed in position with small pins or screws that can be removed when the implants are placed.
* The gum is replaced and stitched carefully back into place.
* The surgery usually takes about 60-90 minutes.
* The stitches are removed about a week later. Once the graft has been confirmed as successful, and the site of the bone graft is totally healed, the next stage of the dental implant process can begin. See our information sheet on dental implants for more information on this stage of your treatment. 


Types of Bone graft used

Your Own Bone
This is the safest and most effective because it integrates very well and there is no risk of infectious disease, contamination or tissue rejection. The bone is typically harvested in your own mouth (from the chin or jaw). Disadvantages of this source are that it requires two surgical sites, is more expensive and the is a limited supply unless more invasive techniqoues are used.

Human Cadaver Bone (Same species)
Freeze-dried and sterile, donor cadaver bone obtained from a reputable tissue bank is more affordable and generally quite safe, although it does carry some risk. Using human bone carries a similar level of risk of transmitting infectious disease to receiving blood from the blood bank.

Animal Bone
Cow bone has been commonly used for many years. It is sterilized and processed to minimize infection, but like human cadaver bone, there is the possibility of contamination. This graft material is naturally absorbed by the body and replaced with real bone over time.

Mineral Bone Substitute (Synthetic/ Laboratory bio-engineered)
Although less-effective than the other options, these sterile bone-like materials are second only to a patient’s own bone in terms of safety. This material is also absorbed and replaced over time.

Please note that some types work best in some clinical cases but not all, therefore your dentist may use a combination of sources to acheive the best result.

What are the Risks?

* Pain, swelling and bruising in the area where the graft (bone) has been taken from.
* Swelling in the jaw at the site of the graft which normally lasts for about one to two weeks.
* Infection and/or failure of the graft. We try to avoid this by using careful techniques and antibiotics.
* Insufficient successful graft bone to accept implants. In these cases further grafting may be necessary.
* The risk of failure is higher in certain individuals, particularly those who smoke, and you will be advised if we think risk of failure is higher than normal in your case.
* There is a higher risk of failure in implants placed into grafted bone rather than natural bone. 


Are there any alternatives?


Synthetic bone substitutes, or bone from animals or other humans, are available but do not perform as well as your natural bone. This is because it is less likely that your body will reject your own bone. On some occasions your bone graft may also be mixed with a synthetic material or bone from another source i.e animal derived products. In some cases a synthetic membrane may also be used to cover and protect the graft. We will inform you of any proposed synthetic graft or membrane, the composition of the graft/membrane and the origin of the graft/membrane (make/type). The choice of material can be discussed.

Video courtesy of MD

Frequently asked questions about Bone Graft

  • How can I prepare?

    Please make sure you have told us about any problems with your health and about any tablets or medicines you are taking. Some medical conditions change the advice and information we need to give you. 
If you are a smoker we strongly advise you to quit and remain a non-smoker in the long term. This will significantly reduce the risk of some implant complications. For help giving up smoking, call the NHS Smoking Helpline on 0800 169 0 169 https://www.nhs.uk/smokefree

  • Will I feel any pain?

    The level of discomfort is variable and generally only requires painkillers, such as paracetamol or ibuprofen, which are available from your local pharmacy. It is better to take these before the local anaesthesia wears off, at the interval prescribed on the packet, for the first 24 hours.
It is possible that some facial swelling and bruising may occur. In order to minimise this apply ice packs to the area for ten minutes per hour, for the first six hours. A simple ice pack can be made by wrapping a small bag of frozen vegetables in a clean cloth.

  • What happens after the procedure?

    If you have had the procedure under local anaesthesia you will be able to leave practice as soon as the procedure has been completed. You will be given a course of antibiotics to take home and use over the following week. In most cases, the graft will be left to heal for a period of three to six to nine months before surgery is carried out to insert the dental implants.

  • What do I need to do after I go home?

    You should be able to return to work within a day or two of your treatment. Occasionally you may not be able to wear your dentures for up to two weeks after the surgery (the dentist treating you will let you know if this is the case).
    You should avoid alcohol for 24 hours. If you are a smoker we strongly advise you to quit and remain a non-smoker in the long term.
    It is not advisable to brush the area where your graft was taken from or inserted into for the first week after surgery. A mouthwash containing chlorhexidine (for example Corsodyl) is recommended to keep the area free of plaque. The mouthwash should be held in the mouth for one minute and this should be repeated twice daily. Please read and follow the instructions on the label.

  • What should I do if I have a problem at home?

    If any bleeding is experienced, roll up a clean handkerchief, press it over the wound and hold it there by closing your jaws firmly together for at least half an hour. If the bleeding does not stop you will need to contact the practice or attend your local accident and emergency (A&E) department.

  • Will I have a follow-up appointment?

    You will need a follow up appointment to check that the bone graft has worked and to plan the next stage of your implant treatment. This appointment will made on the day.
    Any dental restorations or dentures based on implants will need regular follow up and occasional maintenance. We will expect you to be willing to attend for such care, and for regular checks of the implants themselves.

Still have questions?


Book a consultation now for more information on how we can help you with Bone Graft.

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