Dental implants are artificial roots that are inserted into the jawbone to support crowns, bridges, or dentures. The implants need sufficient bone for stability and longevity. If there is not enough bone, the implants could fail over time because the chewing force exerts great pressure on the implants. So, your dentist or oral surgeon may recommend bone grafting for dental implants.
Bone grafting is a surgical procedure that aims to create a solid bone base for dental implants. The procedure is usually performed under local anesthesia. The dentist or oral surgeon makes an incision in the gum and places bone graft material. Then, they close the gum with stitches. The dentist won’t place the implants into the jawbone until complete recovery, which can take from 3 to 6 months to grow enough new bone. In this article, we will discuss:
- Why jawbone loss occurs.
- Is bone grafting necessary, and how it is performed.
- Types of bone grafts.
- Healing time and what to expect after the surgery.
Why Jawbone Loss Occurs
To fully understand bone grafting for dental implants, you should first know why jawbone loss occurs. Jawbone loss is a common consequence of tooth loss. Physical stimuli such as biting and chewing strengthen the jawbone. Every time you eat or chew, the biting or chewing force travels through your teeth to the jawbone, stimulating the jawbone to grow and rebuild. After tooth extraction, the jawbone loses its stimuli, causing the jawbone to lose width, height, and volume.
According to the Indian Journal of Dentistry, the jawbone loses 25% of its width during the first year after tooth extraction. The jawbone loss continues, and the jawbone loses up to 40% of its width over the next few years. Replacing missing teeth with bridges and dentures won’t solve the problem because they don’t transmit the chewing and biting force to the jawbone. Dental implants can prevent jawbone loss because they act like natural teeth roots, and transmits the biting and chewing force directly into the jawbone. Sometimes, the dentist recommends bone grafting for dental implants.
Other Causes of Jawbone Loss
- Advanced gum disease (periodontitis): it is a severe inflammation of the tooth-supporting-tissues, which can lead to the destruction of the supporting bone. When a severe bone loss occurs, the tooth becomes loose.
- Dentures: they sit on the gum tissues. So, they don’t stimulate the jawbone in the same way that the natural teeth do. Dentures don’t cause jawbone loss. However, the extended use of dentures can accelerate the bone resorption process. Bone resorption is mainly the cause of dentures problems such as loose dentures, mouth sores, and difficulty chewing or speaking.
- Trauma: teeth and jaw injury are also associated with jawbone loss. If a tooth is knocked out or broken, the jawbone stimulation stops, leading to the beginning of bone resorption. Besides, jaw trauma can cause bone loss in the years following the initial injury.
- Tumors and cysts: they can cause jawbone loss. Besides, the enlargement of a tumor or cyst increases the jawbone loss, and can even lead to jaw fracture. So, the dentist will surgically remove the tumor or cyst, and perform a bone grafting procedure to preserve the integrity of the jaw.
- Osteomyelitis: it is a serious but rare condition. Osteomyelitis is a bacterial infection in the bone, which can cause a reduction of bone blood supply. To prevent the spread of infection, the oral surgeon may remove the infected bone, and perform a bone grafting to strengthen the area.
- Enlargement of Maxillary Sinuses: the sinuses are air-filled cavities located above the upper posterior teeth (upper molars). When an upper posterior molar is extracted, the maxillary sinus enlarges because of the air pressure, causing bone loss. This process is known as pneumatization, which can leave insufficient bone for implants placement. So, the dentist may recommend a sinus lift surgery and bone grafting for dental implants.
Consequences of Jawbone Loss
Jawbone loss can lead to dental and aesthetic problems. The consequences include:
- Dentures become loose over time.
- Dental implants placement can be hard or even contraindicated due to insufficient bone. In this case, your dentist may recommend bone grafting for dental implants.
- Significant jawbone loss can lead to facial changes (facial collapse), especially in edentulous patients (toothless). This facial changes can make you appear much older because of the loss of bone and teeth that support lips and checks.
- Extreme jawbone loss increases the risk of jaw fracture.
Prevent Jawbone Loss
To prevent jawbone loss, you should replace missing tooth/teeth with dental implants immediately after tooth extraction. Dental implants function in the same way as natural teeth. They transmit the biting and chewing force to the jawbone, which preserves the jawbone and prevents jawbone loss. If you already have a jawbone loss, your dentist may recommend bone grafting for dental implants. Mini dental implants could be a suitable option for you if regular-diameter implants placement is not possible.
Is Bone Grafting for Dental Implants Necessary?
Bone grafting for dental implants is a surgical procedure that involves the replacement of missing jawbone to create a solid base for dental implants. This will ensure the longevity and stability of implants. Not all implant cases require bone grafting procedures. Bone grafting is necessary for patients with insufficient bone because you need enough bone’s height and width to ensure the longevity and stability of implants.
Generally, you need at least 2 mm of healthy bone in front and behind of a dental implant. For example, the jawbone’s width should be at least 8 mm for the placement of a 4 mm implant (2+4+2). Also, you should have sufficient bone height to prevent the injury of maxillary sinuses or nerves. There are other options available that usually don’t require bone grafting procedures such as All-on-4 and mini dental implants. Visit your dentist or oral surgeon to know if bone grafting for dental implants is necessary for you.
How Bone Grafting for Dental Implants Is Performed?
Bone grafting for dental implants is a minor surgical procedure that is performed in the dental office. The procedure is usually performed under local anesthesia. First, the dentist or oral surgeon will make an incision in the gum (gingival flap) to expose the bone underneath. Then, they will place a bone graft material and hold it in place with a barrier membrane. After that, the dentist will close the incision with stitches.
Sometimes, bone grafting can be performed immediately after a tooth extraction if you choose dental implants for replacing missing tooth/teeth. The dentist will place a bone graft material directly into the socket immediately after extraction. Then, they will secure the graft in place with a barrier membrane and close the extraction site with stitches. This procedure is known as socket preservation, which prevents bone loss after tooth extraction and provides a solid base for dental implants.
Types of Bone Grafts
There are four types of bone grafts, which come from different sources.
- Autograft: the bone graft comes from the patient’s own body. The oral surgeon typically harvests the bone from the jaw, hard palate, or chin (intra-oral). If there is insufficient bone in these places, they may take the bone graft from the hip, or shinbone (extra-oral). The autograft has a low risk of immune rejection. However, an additional surgical procedure is needed.
- Allograft: the bone graft comes from another person, usually a cadaver. The allograft is sterile. It is specially treated to eliminate bacteria and ensure no infectious diseases are present. The advantage of the allograft is that the oral surgeon performs the bone grafting without the need for a secondary surgical site on your body.
- Xenograft: the bone graft comes from an animal source, typically a cow or pig. Like allografts, the xenograft is specially treated to eliminate any bacteria or other biological materials.
- Alloplastic graft: It is a synthetic bone graft, which can be made of hydroxyapatite (HA), calcium carbonate, and tricalcium phosphate. Hydroxyapatite is the most frequently used synthetic bone graft due to its strength, durability, and acceptability by bone.
If you need bone grafting for dental implants, visit your dentist to know which type is best for you.
Bone Grafting for Dental Implants Procedure
Minor Bone Grafting for Dental Implants
After the extraction of a tooth, the dentist may place bone graft granules directly into the socket to preserve the jawbone’s height and width. Then, they will cover the bone graft with a barrier membrane, and close the socket with stitches. This procedure is known as socket preservation or minor bone grafting for dental implants.
Medium Bone Grafting for Dental Implants
If you already have a significant jawbone loss, your dentist may recommend medium bone grafting for dental implants. First, the dentist will make an incision in the gum (gingival flap) to expose the bone underneath. Then, they will place bone graft granules. After that, the dentist will cover the bone graft with a barrier membrane, and close the gum tissues with stitches.
Major Bone Grafting for Dental Implants
Major bone grafting is beneficial for patients with severe jawbone loss. The dentist uses a bone block that is harvested from the patient’s own body (autograft). Then, they secure the bone graft block in place with screws and plates. Also, the dentist fills the area with bone graft granules and covers the whole area with a membrane. After that, they close the wound with stitches.
Sinus Lift Surgery
After the extraction of upper posterior teeth, the maxillary sinuses begin to enlarge due to air pressure, causing jawbone loss. This process is known as pneumatization. In this case, the dental implant is contraindicated due to insufficient jawbone volume. So, your dentist may recommend sinus lift surgery and bone grafting for dental implants.
Sinus lift surgery aims to increase bone volume in the upper posterior area for the placement of implants. First, the dentist will make an incision in the gum and create a window into the maxillary sinus cavity. Then, they will carefully raise the sinus membrane and place bone graft granules between the membrane and sinus floor. Also, the dentist will cover the area with a barrier membrane. In the end, the dentist will suture back the gum tissues with stitches.
The healing time depends on many factors, such as the size of the defect, type of bone graft, complexity of the procedure, and overall health. The initial healing may take 2 weeks. However, the dentist or oral surgeon won’t place the implants until a new solid bone mass is formed (complete healing), which can take from 3 to 6 months. The healing time of sinus lift surgery and major bone grafting can take at least 5 to 6 months.
To speed the healing process, follow the post-operative instructions. Also, avoid smoking because it limits the blood flow, which can slow or prevent bone healing.
What to Expect After Bone Grafting Procedure?
Like any surgical procedure, you may experience:
- Discomfort or pain.
- Minor bleeding.
- Gum swelling and/or bruising.
- Possible face swelling.
- Potential bruising on your face.
Therefore, the dentist will prescribe painkillers to control the pain, anti-inflammatory medications to control the swelling, and antibiotics to prevent the infection. These signs and symptoms are normal after the bone grafting procedure. However, if they get worse, contact your dentist immediately.
Instructions After Bone Grafting Procedure
To speed the healing process and prevent complications, you should follow these instructions:
During the First Day
- Bite on the gauze for 30 minutes after the surgery to stop the bleeding.
- Take the prescribed painkillers as soon as you feel the local anesthetic wearing off.
- Don’t disturb or touch the wound.
- Avoid spitting, and don’t rinse your mouth during the 24 hours.
- Take the prescribed anti-inflammatory medications to control the swelling.
- Use cold compress (ice-packs) on the affected side of your face for 48 hours to minimize the risk of swelling.
- Take the prescribed antibiotics as directed to prevent the infection.
- Maintain good oral hygiene to speed the healing process.
- Don’t drink alcohol.
- Don’t smoke for at least 2 weeks because smoking can slow or inhibit bone healing.
- Eat soft, cool foods and drinks such as yogurt, pudding, and mashed potatoes.
- Avoid hot foods and drinks because they may promote healing.
- Eat a proper diet to help you heal faster.
- Avoid foods such as nuts, seeds, chips, and popcorn.
- If you have dentures, don’t wear them.
- Avoid exercise or lifting heavy objects.
After 24 Hours
- Continue taking the prescribed painkillers, anti-inflammatory medications, and antibiotics.
- Rinse with warm salt water (½ a teaspoon of salt to a cup of warm water) in the day following the surgery. Rinse your mouth 4-5 times a day.
- Brush your teeth with a soft-bristled toothbrush, and avoid the wound area.
- Use warm compress (heating pad or warm washcloth) after 24 hours to help reduce the swelling.
- Return gradually to your normal diet, unless otherwise directed.
If the pain and swelling get worse after the bone grafting surgery, contact your dentist immediately.
Risks of Bone Grafting for Dental Implants
Bone grafting for dental implants is a safe procedure. However, like any surgery, there are possible complications and risks. The potential risks include:
- Pain and swelling.
- Post-operative bleeding.
- Nerve injury, which can cause numbness of gum, lip, and/or cheek.
- Perforation or tear of the maxillary sinus membrane.
- Bone graft rejection.
- Failure of the bone graft to achieve its goal.
The oral surgeon makes an incision in the gum to expose the bone underneath. Then, they place a bone graft material and cover it with a barrier membrane. In the end, the oral surgeon closes the incision with stitches. The procedure is usually performed under local anesthesia.
Like any surgical procedure, you may experience discomfort, swelling, and minor bleeding. If these signs and symptoms get worse, contact your dentist or oral surgeon immediately.
The initial recovery period can take at least 2 weeks. However, the oral surgeon won’t place the implants until a new solid bone is formed (complete recovery), which can take from 3 to 6 months.
Probably not. The procedure is usually performed under local anesthesia. So, you shouldn’t feel much during the procedure. After the surgery and for a few days, you may feel some discomfort or pain. So, your dentist may prescribe painkillers to help you control the pain.
- Dental implants need sufficient bone for stability and longevity.
- The jawbone loses 25% of its width during the first year after tooth extraction.
- Bone grafting is a surgical procedure that aims to create a more solid base for dental implants.
- The bone graft material comes from four different sources: from the patient’s own body, a doner, animal source, or synthetic material.
- Bone grafting for dental implants is not always necessary. It is beneficial for patients with a thin or insufficient jawbone.
- The oral surgeon won’t insert the implants into the jawbone until complete recovery, which can take form 3 to 6 months.
- It is normal to experience discomfort or swelling after the procedure.
- Follow the post-operative instruction to speed the healing process and prevent complications.