After tooth loss, the jawbone gradually decreases; when planning an implant, bone augmentation procedures come onto the agenda if bone width or height is insufficient (Resnik & Misch, 2018).

Main approaches

• Guided bone regeneration (GBR): Closing the defect with graft and a barrier membrane; implant survival in areas augmented with barrier membranes has been examined in systematic reviews (Hämmerle et al., 2002).
• Block bone graft: Repair of large defects with a block graft taken from an intraoral site (Levin et al., 2007).
• Socket preservation: Approaches aimed at reducing bone shape loss after extraction (Becker et al., 2002).

Risks and limits

Complications (membrane exposure, infection, graft loss) are possible and vary with the graft type (Chaushu et al., 2010; Chiapasco & Zaniboni, 2009). Results differ with the person and defect type.

Why is bone lost?

After a tooth is extracted, stimulation from the tooth root to the bone in that area stops and the bone gradually decreases. Gum disease, infection, denture pressure and trauma can also increase bone loss. When planning an implant, bone width, height and quality are evaluated together (Resnik & Misch, 2018).

Graft materials and membranes

The graft can be the patient’s own bone (autogenous), donor human bone, animal-derived or synthetic materials. Barrier membranes cover the graft and prevent soft tissue from entering the graft area (Hämmerle et al., 2002). Which material is chosen depends on the size of the defect, the site and the patient’s preferences.

When is a block graft considered?

In large bone defects, a block of bone, usually taken from another area of the jaw, is fixed to the implant bed. Implant success in intraoral block grafts has been investigated (Levin et al., 2007); however, it requires a second surgical site and the healing period can be longer. Complications have also been reported with allograft blocks (Chaushu et al., 2010).

What to watch after grafting

• Do not put pressure on the area; if there is a temporary denture, do not use it without the dentist adjusting it.
• Do not smoke or reduce it significantly.
• Follow the oral care and mouthwash program recommended by the dentist.
• Do not miss check-up appointments.

The time needed for graft healing varies with the method. If there is opening, pus or increasing pain in the graft area, seek care without waiting.

Frequently asked questions

Is a bone graft needed for every implant?

No; only if bone is insufficient.

Is the graft taken from my own bone?

The patient’s own bone, donor or synthetic materials can be used; the dentist makes the choice.

How long is the wait after grafting?

The bone formation time varies with the method; the dentist plans it. See our implant treatment page for details.

Is a bone graft painful?

It is done under anesthesia; swelling and tenderness are expected afterwards and the dentist plans pain management.

Is the graft rejected by the body?

Graft materials are chosen to be biocompatible; still, complications such as infection or graft loss can rarely occur (Chiapasco & Zaniboni, 2009).

When is the implant placed after grafting?

The dentist determines the timing by evaluating bone healing.

For an oral surgery evaluation you can book an appointment or browse the other articles in our Dental Health section. You can reach us from Bahçelievler, Bakırköy, Güngören, Haznedar, İlkyuva, Basınsitesi and the European side.

References

• Resnik, R. R., & Misch, C. E. (2018). Misch’s avoiding complications in oral implantology. Elsevier.
• Hämmerle, C. H. F., Jung, R. E., & Feloutzis, A. (2002). A systematic review of the survival of implants in bone sites augmented with barrier membranes (guided bone regeneration) in partially edentulous patients. Journal of Clinical Periodontology, 29(Suppl. 3), 226–231. PubMed ↗
• Levin, L., Nitzan, D., & Schwartz-Arad, D. (2007). Success of dental implants placed in intraoral block bone grafts. Journal of Periodontology, 78(1), 18–21. PubMed ↗
• Chiapasco, M., & Zaniboni, M. (2009). Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: A systematic review. Clinical Oral Implants Research, 20(Suppl. 4), 113–123. PubMed ↗
• Chaushu, G., Mardinger, O., Peleg, M., Ghelfan, O., & Nissan, J. (2010). Analysis of complications following augmentation with cancellous block allografts. Journal of Periodontology, 81(12), 1759–1764. PubMed ↗
• Becker, W., Hujoel, P., & Becker, B. E. (2002). Effect of barrier membranes and autologous bone grafts on ridge width preservation around implants. Clinical Implant Dentistry and Related Research, 4(3), 143–149. PubMed ↗

Note: Book chapter references follow the page ranges of the publisher’s edition; article links open the matching PubMed record.

This article is for information only and is not medical advice. See your dentist for diagnosis and treatment; no outcome is guaranteed.

This page was reviewed by Dr. Dt. Mehmet Fuat Bozaba, periodontist.