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Does Everyone Need Bone Grafting During Dental Implant Surgery?

by — Last updated: 2020-05-20 in Ear, Nose, Throat, and Dental problems

Successful dental implant treatment depends on having adequate bone to support the implants. What if you don't? That is where bone grafting comes in. Here is what you can expect from a bone grafting procedure.

The way in which a dental implant restores the cosmetics and function of a lost natural tooth is unmatched. A well-placed implant and prosthesis are virtually undetectable — and closest thing to replacing a natural tooth.

Dental implants are a safe and durable way of replacing missing teeth. They are also safer for adjacent teeth, because implants don't take support from them like tooth-supported bridges or dentures do.

Not everyone needs bone grafting during a dental implant procedure. Only people with an inadequate amount of bone to support the dental implants need grafting.

Bone loss around the teeth

As soon as a natural tooth is extracted, the supporting bone starts dissolving. Nature is pretty efficient and does not retain inactive tissues. Over a period of time, bone loss can grow so significant that there may not be enough remaining to support a dental implant.

Sometimes, there might be some infection around the roots of a natural tooth due to untreated deep decay. This infection slowly dissolves the bone around the roots as well.

Chronic gum diseases caused by poor oral hygiene or some underlying systemic conditions can gradually reduce the height of the bone, eventually loosening the natural teeth and leading to their loss.

In cases of fractured bone around the tooth due to trauma, as healing occurs, there may be a loss of bone height as well.

What is bone grafting?

Bone grafting is a surgical procedure that helps rebuild the lost bone by transplanting bone from a healthy site in the patient’s body, or by using an artificial bone substitute.

Why is bone grafting needed for dental implants?

Dental implants get all their strength and support from the jaw bone. Once the implant is placed inside a bone, it starts fusing with the surrounding bone in a process known as osseointegration. This may take anywhere from three to six months, depending on the site of the implant, the condition of the jaw bone, and the overall patient health.

A healthy jaw bone with adequate height and thickness is absolutely necessary for a successful implant. Without an adequate amount of bone, a dental implant procedure is impossible.

Ideally, at least 2 mm of healthy bone is needed all around the implant to ensure adequate stability and support for a successful procedure. According to literature and available studies, more than 50 percent of implant procedures require some sort of grafting procedure to provide support and restore the lost contour of the jaw bone.

Types of bone grafts in dentistry

Several types of bone grafting procedures are used in implant dentistry, depending on the amount of bone that needs to be regenerated and the site at which this regeneration is needed.

Socket graft

This is one of most common types of grafting procedures used in implant dentistry. Bone substitute is added into the bony socket immediately after the extraction of the tooth. This helps minimize the bone loss normally seen after extraction and the site is ready for a dental implant in four to six months.

Lateral grafts

These types of grafts are used to increase the width of the jaw bone. A small length of bone is added on the side of the jaw bone. The bone is typically harvested from the patient’s body.

Block grafts

These types of grafts are used when large parts of the bone are missing from the jawbone due to trauma, infection, or due to surgical removal of bone in cases of oral cancers. A large chunk of bone is usually harvested from the back of the jaw, and secured in place using small titanium screws. The sites of lateral grafts or bone grafts are usually ready for implantation in approximately six months.

Sinus lifts

This procedure is carried out in the upper jaw when the maxillary sinus is close to the oral cavity in the jaw bone. The sinus is accessed through the jaw bone, and bone powder is added in such a way that the sinus membrane is elevated and adequate bone height is achieved. Implants can be placed either immediately or at a later stage.

Is bone grafting painful?

All bone grafting procedures are carried out under local anesthesia or sedation so there is no pain during the procedure. Once the effect of anesthesia wears off, patients may experience some discomfort, similar to that felt after tooth extraction, which is easily manageable with medication.

In cases where blocks of bone are harvested for grafting, some swelling and bruising may be seen.

How soon can implants be placed after bone grafting surgery?

In cases where there is only a minor defect, or in cases like sinus lift, implants can be placed along with the bone graft itself. However, in cases where extensive grafting is done, healing may take up to one year. Follow up x-rays are taken to determine the healing, and accordingly, implant surgery is planned.

Conclusion

Diagnostic tools like CBCT are extremely helpful in determining if a case will require bone grafting. If your dentist does feel that you need to undergo a grafting procedure, there is no need to worry too much about it.

Bone grafting is quite a common supportive procedure for dental implants and can greatly increase the chances of a successful outcome by providing the required support to the implant. Bone grafting can also greatly improve the aesthetics of the gums in the front region of the jaws by restoring the lost contours.

  • Photo courtesy of SteadyHealth