Bone grafting
About bone grafting
If you’re having dental implants placed, and your jawbone isn’t thick enough, a bone graft or augmentation may be required. Depending on your needs, this could take place before or during your implant procedure. During your consultation, your dentist will let you know if bone augmentation is required and talk through your treatment options.
We know the procedure may sound daunting, but it’s fairly common and your dentist will support you through the entire process and talk you through dental sedation options.
What is bone augmentation?
A dental implant is a titanium screw that’s fitted into your jawbone, replacing the tooth root. To be suitable for an implant, your jawbone needs to be thick enough to support it.
There are some reasons why you might not have enough bone. When teeth are lost or extracted, the bone surrounding your tooth root can shrink gradually. Gum disease, infections and injury to the mouth can also lead to bone loss.
Bone augmentation or grafting is a solution. Both procedures replace lost bone using either bone from another part of your mouth, or one or more types of substitute material.
Depending on how much bone shrinkage has occurred, there are various treatment options available, including:
- Minor bone augmentation: Also called simultaneous augmentation, this procedure can be performed around an implant while it’s placed.
- Staged bone graft: If too much bone has shrunk, a staged bone graft may be required six months before the implant is placed.
How do I know if I’ll need a bone graft?
During your dental implant consultation, your dentist will carry out a thorough clinical assessment to find out if you’ll need bone augmentation. They may also take a 3D scan to show the thickness of the bone, which can’t be seen on a normal X-ray.
How much is a bone graft in the UK?
The cost of a bone graft or augmentation depends on your requirements. During your consultation, your dentist will determine the specific treatment you’ll need and talk you through the likely costs. They’ll then produce your bespoke treatment plan, giving an accurate estimate of the costs, timescale, risks and benefits of your treatment.
At Bupa Dental Care, we offer payment options to spread the cost of your treatment. Contact your local practice to find out more.
What materials are used for dental bone grafts?
There are two materials involved in a bone graft or augmentation: bone filler and a barrier membrane.
- A bone filler: the material that replaces the bone that’s lost. Some common bone fillers include:
- - Your own bone can be used for filler, which is called an autograft. Bone may be collected from the implant placement site or another site in the mouth.
- - Bone made from animal biomaterials. This is called a “xenograft” and has been used safely for decades
- - A completely synthetic material called an “alloplast,” created in a laboratory
- A barrier membrane: to protect the bone graft material as new bone develops, your dentist will cover the graft with a coating called a barrier membrane. Resorbable membranes can be used, which dissolve and don’t need to be removed, or non-resorbable, which need to be removed surgically.
What are the different types of bone augmentation?
As well as a minor bone augmentation and staged bone grafting, other options include a sinus lift and ridge preservation.
Minor bone augmentation
If minimal bone loss has occurred, minor bone augmentation, also known as simultaneous augmentation, can be used. It can be performed during implant placement and increases the amount of bone around an implant, to ensure your gums stay healthy.
The graft material used often includes some of your own bone, mixed with a bone filler, and is covered with a collagen barrier membrane.
It’s normal to experience some discomfort, swelling and bruising for approximately one week after this procedure.
Staged bone grafting
If there’s too much bone loss to be able to place an implant in the correct position, a staged bone graft can be performed.
The graft material could include some of your own bone, taken from your lower jaw, or a donor bone block (an allograft), depending on your preference. This may be mixed with a bone filler and will be covered by a barrier membrane.
A staged bone graft needs to be performed six months before an implant is placed, to allow your mouth to heal. During this time, your own natural bone will develop within the grafted space.
Side effects may include some discomfort, swelling and bruising for approximately one week after the procedure.
Sinus lift
Placing implants at the back of your upper jaw can be impacted by air spaces in your face, known as the sinuses. If the sinus is close to the roots of your upper teeth, this may mean there isn’t enough bone to support dental implants.
The solution is a sinus lift procedure, involving adding bone below the sinus space, above your upper back teeth.
Sinus lift procedures can be performed during implant placement, or six months before. This usually depends on the amount of bone loss in the area.
After a sinus lift, you'll experience some discomfort, swelling and bruising for a few weeks, and may need to take some time off work. You may also experience some sinus congestion or nosebleed in the week following the surgery.
Ridge preservation
A part of your jawbone contains sockets for the roots of your teeth, and this is called the alveolar ridge. When teeth are removed, the bone and ridge they were sitting in gradually shrinks. The more the bone shrinks, the more difficult it is to place an implant in exactly the right position.
If your implant surgery is delayed for over a few months post extraction, it can be helpful to place bone filler into the socket(s). This helps avoid the shape of the ridge shrinking.
After a ridge preservation procedure, the extraction site may be slightly sorer than it would be from just after an extraction.
What are the risks of dental implant bone grafts?
There are always risks with any type of surgery; your implant dentist will talk these through with you and answer any questions. When carried out by an experienced implant clinician, these risks are rare.
- After surgery to the lower jaw, temporary or permanent numbness/ altered sensation of the lip, teeth and/or tongue can occur in rare cases. This is a sign of nerve injury and requires urgent treatment. Symptoms include feeling like the anaesthetic hasn’t worn off, and/or episodes of intense pain in the lip and lower jaw. If you experience either symptom, contact your dentist as soon as possible.
- Depending on how much bone and soft tissue is lost from the implant site, it’s not always possible for your implant and false tooth (crown) to have an ideal appearance. Complete reconstruction of the gums can’t be guaranteed, and the false tooth may appear longer at gum level than the natural teeth to it. Soft tissues, such as the gum, aren’t completely controllable and recession could occur unexpectedly. In some cases, your dentist may be able to add pink material to the final bridge or crown, simulating missing gum tissue.
How do I care for my mouth after bone augmentation?
Your dentist will give you clear guidance on how to care for your bone graft, including the instructions below. Success rates are very high when carried out by a trained and experienced implant dentist or surgeon, and if you follow the aftercare instructions carefully.
Managing discomfort
- Discomfort is usually minimal and resolved after four or five days. Any pain can be managed using ibuprofen or paracetamol, as per your dentist’s instructions.
- You may experience swelling which usually peaks after two to three days, then reduces. This could be accompanied by bruising and stiffness, or jaw joint pain, which could be managed by following your dentist’s aftercare instructions.
- You may find blood in your saliva for the rest of the day. This is normal and not a cause for concern.
Diet and lifestyle
- Eat a soft diet for one week after the procedure, avoiding chewing near the operation site.
- Do not rinse your mouth or have hot drinks for at least six hours. Cold drinks are fine.
- You must not smoke for at least two weeks after surgery, to avoid interference with healing. Ideally, patients are advised to give up smoking altogether. You should also avoid alcohol for a week and excessive alcohol consumption until the graft heals.
- Avoid physical exertion for the first few days after surgery and refrain from swimming.
Caring for your mouth
- After six hours, start warm saltwater mouthwashes. These should be done four to five times a day, for five days.
- Clean your teeth as usual, but don’t brush over the operation site until your dentist instructs you to. Your dentist can recommend a mouthwash to bathe the area twice each day.
- Attend regular hygiene appointments to help avoid gum disease. Severe stages of gum disease could lead to tooth or implant loss.
- You cannot wear your denture until prescribed to do so, which is usually after at least two weeks.
- Ensure to take any prescribed antibiotics as directed.
More about implants and bone grafting
Find out more about dental implants and how to look after your bone graft.
Dental implants
What are implants? How much do they cost and what does the procedure involve?
Sinus lifts
Learn more about sinus lift procedures, including what’s involved and how much they cost.
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