Dental implants are artificial tooth roots inserted into the jawbone to provide a stable foundation for 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 strong foundation 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 new bone growth takes 3 to 6 months.
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 transmit 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 (periodontal disease): The advanced stage of gum disease, also known as periodontitis, causes the destruction of the tooth-supporting tissues, such as gum tissues, periodontal ligaments, and jawbone. 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 denture 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 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.
- 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 implant placement. So, the dentist may recommend sinus lift surgery and bone grafting for dental implants.
- 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.
Consequences of Jawbone Loss
Jawbone loss can lead to dental and aesthetic problems. The consequences include:
- Dentures become loose over time.
- Dental implant 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). These 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.
How to 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 a 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 mass (height and width) for implant placement to ensure the longevity and stability of implants.
Generally, you need at least 2 mm of healthy bone in front and behind a dental implant. For example, the jawbone’s width should be at least 8 mm to provide a solid foundation 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.
Types of Bone Grafts
There are four types of dental bone grafts, which come from different sources. Types of bone graft materials include:
- Autograft
- Allograft
- Xenograft
- Alloplastic graft
Autograft comes from the patient’s own body. The oral surgeon typically harvests a small piece of bone from the jaw, hard palate, or chin (intra-oral). If there is insufficient bone in these places, they may take a block 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 comes from another person, usually a cadaver. The allograft is sterile. The human bone allograft 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 comes from an animal source, typically a cow or pig. Like allografts, the xenograft is specially treated to eliminate bacteria or other biological materials.
An Alloplastic graft 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 of graft is best for you.
How Bone Grafting for Dental Implants Is Performed?
Before undergoing a dental implant procedure, you will have a consultation with your oral surgeon. They will evaluate your oral health, take dental X-rays or scans to assess the condition of your jawbone, and determine if bone grafting is necessary.
Bone grafting for dental implants is a minor surgical procedure 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.
After the bone grafting procedure, it is crucial to follow post-operative instructions provided by your oral surgeon. This may include taking prescribed medications, maintaining a soft food diet, and avoiding activities that can disrupt the healing process.
Socket Preservation
Your dentist may recommend a socket graft procedure immediately after tooth extraction. This procedure involves the placement of bone graft granules directly into the extraction socket to preserve the jaw bone’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 socket graft procedure.
Major Bone Grafting for Dental Implants
Major bone grafting, also known as block bone graft, is beneficial for patients with severe jawbone loss. The oral surgeon uses a block of bone harvested from the patient’s own body (autograft). Then, they secure the bone graft block in place with screws and plates. Also, the oral surgeon fills the area with bone graft granules. Then, they cover the block bone graft with a membrane and close the wound with stitches.
Sinus Lift Procedure
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 jaw bone volume. So, your dentist may recommend sinus lift surgery and bone grafting for dental implants.
Sinus lift surgery aims to increase bone mass in the upper posterior area for the placement of implants. First, the oral surgeon 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 the sinus floor. Also, the oral surgeon will cover the area with a barrier membrane and suture back the gum tissues with stitches.
Ridge Augmentation
Ridge Augmentation is another type of bone grafting procedure that may be recommended for dental implants. When a tooth is lost or extracted, the bony ridge may become thinner or narrower, resulting in an insufficient amount of bone for implant placement.
During a ridge augmentation procedure, the oral surgeon will make an incision in the gum tissue near the ridge and expose the underlying bone. They will then use specialized instruments to carefully shape and expand the existing ridge. Next, bone graft material will be placed in the expanded ridge to promote new bone growth. The area will be covered with a barrier membrane and the gum tissue will be stitched back into place.
Healing Time
Recovery 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.
In most cases, the 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. Sometimes, the oral surgeon may perform dental implant surgery and bone grafting at the same time.
The healing time of sinus lift surgery and major bone grafting can take at least 5 to 6 months.
To speed up the recovery time and bone growth, follow the post-operative instructions. Also, avoid smoking because it limits blood flow, which can slow or prevent bone healing.
Is Bone Grafting for Dental Implants Painful?
Probably not. The procedure is usually performed under local anesthesia. So, you won’t feel pain during the procedure. However, some discomfort, pain, and swelling can be expected for 4-7 days after the procedure. So, your oral surgeon will prescribe over-the-counter pain relievers and anti-inflammatory medications. Antibiotics may also be prescribed to prevent infection.
What to Expect After Bone Grafting for Dental Implants?
Like any surgical procedure, you may experience:
- Discomfort or pain.
- Minor bleeding.
- Gum swelling and bruising.
- Possible face swelling.
- Potential bruising on your face.
Therefore, the dentist will prescribe pain relievers, anti-inflammatory medications to control the swelling, and antibiotics to prevent the infection. These signs and symptoms are normal after the dental 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 over-the-counter pain relievers 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 a 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 cool, soft foods and drinks, such as yogurt, pudding, and mashed potatoes.
- Avoid hot foods and drinks because they may delay 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) on 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 a 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:
- Infection.
- Pain and swelling.
- Excessive 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.
Key Points
- 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 human bone, an 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.
- In most cases, the oral surgeon won’t insert the implants into the jawbone until complete recovery, which can take 3 to 6 months.
- It is normal to experience discomfort or swelling after the procedure.
- Follow the post-operative instructions to speed up the healing process and prevent complications.
