What is Bone Graft Surgery?

Periodontal disease is the severe form of gum disease. As the advanced form of it progresses, it erodes the gums, the structures that hold the teeth in place, and the jaw bone. The erosion can become severe, making a periodontal bone graft the only option available when replacement teeth are desired.

Another process that thins out the jawbone is when teeth have been missing for some time. Some of the bone in that spot – about 40 to 60 percent of it – is reabsorbed, leaving it thin. When replacement teeth, such as dental implants, are going to be inserted into the jawbone, a bone graft for a dental implant may be needed to make the bone large enough to support it. Without a bone graft, the individual is likely not a good candidate for the procedure.

An oral bone graft can use either natural or synthetic material. When using the patient's own bone material (autogenous), bone graft surgery may take the bone from the wisdom tooth area, the chin, the upper jaw, or if more bone is needed than usual, it may be taken from the hip or the knee. Other sources include prosthetics (composites), cadavers (allogeneic), or animal bone (xenogeneic).

When patients have enough jaw bone present, it may be possible for them to get the implant on the same day as an extraction. This may include a full set of dentures that are implant supported. The periodontist will have to make that decision.

When it is determined that there are insufficient amounts of bone, bone augmentation is used in three different procedures. Each of them is necessary in order to get dental implants.

• Ridge augmentation – This procedure is needed when the bone around a tooth has diminished, or when it is unable to heal. Ridge augmentation is often performed in preparation for a dental implant if there is not enough bone to support it. Bone graft material is placed into the socket in order to restore the height and width necessary for the implant. It is usually performed under a local anesthesia.
• Sinus Lift – This procedure is performed when implants are needed in the rear of the upper jaw. If the bone has thinned in height, it may not be thick enough to hold the implant. This means that the sinus cavity is too close. A sinus lift places bone material to heighten the bone so that an implant can be securely positioned without touching the sinus cavity. It is usually performed under local anesthesia.
• Nerve Repositioning – When the jawbone has thinned out in height, particularly in the case of the lower back teeth, the nerve (the inferior alveolar nerve) that sends signals to and from the lower jaw and chin may be too close to place a dental implant. Nerve repositioning surgery involves moving the nerve slightly and then filling in the pockets left behind with bone grafting material. This surgery is performed under IV sedation or general sedation.

Each dental bone graft procedure requires that the graft osseointegrates with your natural bone. This means that your natural bone must attach to the new graft and actually become a part of it. Oral surgeons will often add materials to speed up the process, such as in guided-tissue regeneration (GTR).

When there is a bone graft for implant procedure, the site must be totally healed before the implant can be installed. This generally occurs in about six months, but each individual is different. When your own bone material is used for the graft, healing will be slightly faster than with other materials.

Following the surgery, patients may expect:

• Some swelling of the face, cheeks, eyes, and mouth
• Prescription pain relievers for a couple of days will be necessary, followed by over-the-counter pain relievers
• Antibiotics to reduce the likelihood of infection
• Diet of liquids for 24 hours, and then slowly progress toward solid foods
• Use salt water to rinse your mouth out after meals on the next day (4-5 times per day)
• Avoid strenuous exercise for two or three days.
• Use antimicrobial mouthwash
• Brush teeth, but do not disturb the graft site.

Once you are healed from the bone grafting procedure, you will be able to enjoy the benefits of it. They include:

• Maintains your bone structure – Prevents normal bone loss.
• Prepares you to receive dental implants – enables people with a natural bone loss to obtain implants – the best way to replace teeth.
• Restores the natural appearance of the face – As jawbone mass decreases, your jaw can be deformed, affecting chewing, speech, and may cause pain.
• Makes you look younger – A shrinking jaw due to bone loss will make you look older. Bone grafts can refill your face, help remove some wrinkles, and make you look younger.