So you know about dental implants, but what about another part of the procedure that will be of utmost importance for the successful treatment of some patients? Bone grafting is not always required in implantation, but it is seldom enough touched upon when discussing implantology that those who do need it may be daunted by the sound.
Fear not. Define’s team are dedicated to giving patients all the information, and when it comes to bone grafts we’re here to settle your nerves and tell you all you need to know.
Bone grafts, sometimes called block grafts, are actually a reasonably simple procedure intended to increase the width and height, and thus integrity, of the jaw bone at the site of an implant. The clinician performing the procedure will take bone graft tissue or material (and there are different types!) and attaching it to the compromised area of bone. The material used will also contain collagens and proteins that encourage bone growth, to maximise the effectiveness of the procedure.
When going in for a bone graft you can expect one of three types of material to be used for grafting;
Autogenous: This is likely the kind of grafting people are most familiar with. This is where the bone will be taken from elsewhere on the body, also referred to as a donor site. Common donor sites for jaw bone grafting are the chin, back of the jaw, or occasionally the hipbone. When the material is taken from the patient, it minimises chances of the body rejecting the bone.
Allograft: This is when the bone used is donated by another human. These work in exactly the same way as autogenous grafts do, except the material is not originally from the bone graft patient.
Xenograft: This is when the grafting material is taken from an animal. The two most common types used are equine (horse) or bovine (cow.)
Alloplast: This is when an inorganic, synthetic bone substitute is used as the grafting material. The substitute has a similar chemical makeup to human bone, and can promote new natural bone formation.
Great question. Since dental implants are rooted in the jaw bone, for an implant to be both successful and long-lasting there must be sufficient bone mass at the implant site to support the implant, and for osseointegration to take place. We’ve touched on osseointegration in our dental implants post, but just to refresh your memory, osseointegration is when a biocompatible material (in this instance, the titanium implant) heals and bonds to bone as it does so. Without sufficient bone mass and integrity, this process cannot take place, and so the implant will fail.
The unfortunate truth is that for a lot of patients, a bone graft may well be required, as one of the leading causes of bone loss in the jaw is tooth loss. Once you lose a tooth, or have one extracted, the bone surrounding the now-absent tooth recesses or is lost. The rate of bone loss varies from patient to patient, but largely speaking it is an inevitable consequence of losing a tooth, so tooth loss is always better acted upon sooner rather than later to prevent or reduce the effects.
Moreover, if you’ve previously had oral health issues, such a gum disease or periodontal disease, or perhaps an injury or trauma to your face or jaw, bone quality in the jaw may have been compromised.
Patients may also require a bone graft if the maxillary sinus is too close to the upper jaw, which can be simply down to individual genetics – sinus size and shape differ from person to person. Your age can also affect this, because as you get older your sinuses can enlarge. In this sort of scenario, a patient would require what’s called a sinus lift, a type of grafting procedure.
No. In fact, there are two types of grafting procedure, and the one to which you are best suited would be decided upon consultation. The two types are:
Sinus lift or Augmentation: Your implantologist may suggest a sinus lift if there is insufficient bone mass in your upper jaw. The purpose of a sinus lift is to elongate the bone in your upper jaw, where your molars and premolars sit. To do this, the bone graft will be inserted between the jaw and maxillary sinuses (which sit on either side of your nose) and to make space for the graft the sinus membrane will be lifted or moved upwards.
Onlay Graft: The other type of grafting procedure is an only graft. For this procedure, the grafting material is added or laid directly onto the surface of the compromised bone. Over time and as this heals, the new material will bond to the graft site.
It’s important to understand – and not very well known – that dentures do not prevent bone recession or resorption. A denture may address the aesthetic issue presented by missing teeth, but because they are a superficial device, they do nothing to halt bone loss. This is why over time patients often find that their dentures get looser and cease to fit he same as when they were first fitted, which eventually can lead to difficulty with speaking and eating, and gum soreness. Dental implants, however, can aid in preserving bone, since they are rooted in the jaw bone, much as a natural tooth would be. Additionally, having the implant anchored in the jaw means that when using your mouth, for instance whilst eating and talking, you will be stimulating the bone, which in turn increases bone density over time and makes the jawbone stronger.
Bone mass evaluation is done with a CT scan, an advanced sort of x-ray which produces a 3-dimensional image of the patient’s bone mass. From the scan, a dentist can see bone density, height, anatomical structure and more. These scans enable the treating dentist to evaluate whether a patient is fit for implants, and whether or not they require additional treatment.
Intrigued and want to know more, or if you might be suitable for implants? We’re here for you – at Define our dental team is led by award-winning dentist Dr Alfonso Rao, who has many years’ experience in implant dentistry, and is a member of the Association of Dental Implantology, so you’re in very safe hands indeed. Come visit us in Beaconsfield, Buckinghamshire and start your journey to a stronger smile today!
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