A bone graft is a procedure where a new bone is placed within your existing bone to let your body build more bone in that area for sufficient support.
When the grafted bone integrates with the existing bone, it improves the quantity of the bone, making it denser and more robust overall. A healthy, strong bone will keep the tooth roots integrated within the bone and prevent them from falling.
Moreover, a stronger bone is the foundation for tooth replacement options like dental implants that fuse with a stronger jaw bone to become functional. Let’s learn more about the dental bone grafting process to help you decide whether you need it.
What is Dental Bone Grafting?
Bone loss is a common side effect of periodontal diseases and tooth loss. To cover the defect, bone augmentation or bone grafting is done.
The graft may be taken from another part of your body, such as donor bone, animal bone, or synthetic bone. The procedure restores the structure, function, and appearance to give you a youthful feel and look.
A dental bone grafting performed after a tooth extraction is to maintain the width and height of the bone. Otherwise, it would undergo atrophy.
As the bone grows based on tooth stimulus, there is no deposition and massive resorption once the tooth is lost. The bone augmentation is meant to provide a basic foundation for implant placement.
Moreover, bone resorption outweighs bone deposition in severe gum diseases and periodontal diseases.
To support the existing teeth and dental implants, dental bone grafting is done in patients with gum diseases to introduce healthy bones in the mouth.
Types of Bone Grafts
Bone grafts can generally be classified as natural or synthetic.
A) Natural Bone Grafts
Autografts: When a bone is harvested from an unaffected site from a person’s own body, it is called an autograft. The popular extraction site is the posterior iliac crest near the hip bone and ribs, showing the highest bone growth potential.
Autogenous grafts are gold-standard bone grafts since there are no chances of graft rejection of the body and zero risk of transmitting diseases.
Allografts: Grafts that are harvested from living donors or cadavers are called Allografts. These grafts are processed to minimize the risk of host-versus-graft reaction. The grafts are stored in a frozen environment for long-term use.
Although the graft is processed, there’s a risk that the body receiving the graft will reject it because of the difference in the surface markers of the host and donor cells.
Xenograft: A graft obtained from an animal, usually a cow, is called a Xenograft. However, the success rate of this graft is lower than autograft and allograft; it acts as a scaffold in which natural bone grows.
B) Synthetic Bone Graft
Metal: Metals are readily accepted by human tissues. It is structurally similar to the bone inside and offers corrosion resistance.
Ceramic: Ceramic grafts comprise calcium phosphate, calcium sulfate, and bioactive glass. There’s no risk of disease transmission and host rejection with this graft. It easily integrates with the bone and forms a new bone over time.
Polymer-based bone substitutes: These polymer structures provide a scaffold structure for the bone that promotes bone formation. There is no risk of graft rejection and disease transmission with this one as well.
Coralline Hydroxyapatite: It is obtained from calcium carbonate extracted from sea coral. It promotes the fastest bone growth when compared with synthetic hydroxyapatite.
What are some pros and cons of the dental bone grafting procedure?
Grafting Pros
- Tooth loss and bone loss directly affect your appearance. Bone augmentation restores your bone levels to make you look young and radiant.
- With periodontal disease, you’re at a risk of losing most of your teeth. Grafts will help anchor the existing teeth by ensuring bone growth around the roots.
- The patients experience minimal pain after the surgery.
- Synthetic bone grafting materials are FDA-approved and provide no rejection by the body.
Grafting Cons
- Allografts and xenografts may provide rejections as the body sometimes fails to accept tissues from the donor. This may give rise to complications like infection and abscesses.
- Tooth extraction before bone graft may cause a dry socket.
- There is a risk of dental graft failure, and you may need to repeat it.
The Dental Bone Grafting Procedure
A) Preparing For the Procedures
Initial Consultation: Your dentist or oral maxillofacial surgeon will evaluate your oral health and look into your medical history to give you a go-ahead for a bone grafting surgery. 3D X-rays or CBCT of your jaws will be conducted to identify the precise location of your bone.
Pre-Operative Instructions: Certain patients are asked to avoid certain medications that could interfere with wound healing, such as aspirin and warfarin. Patients are provided instructions on fasting before the procedure and nothing per oral if general anesthesia is used. Pre-procedural antibiotics are prescribed to prevent infections.
Choosing the Graft Material: Autografts, Allografts, Xenografts, and synthetic grafts can be chosen depending on your choice and the patient’s condition.
B) The Grafting Process
Anesthesia: Either the patient is treated under local anesthesia or general anesthesia. Local anesthesia will numb the localized area, sometimes paired with sedation.
Incision and Preparation: An incision is made in the gum to expose the bone where the graft had to be placed. The site is cleaned to remove any damaged or infected tissue.
Placing the Graft: The graft material is placed at the site, and the gum tissue is repositioned and sutured over the graft. In some cases, a collagen mesh is placed on top to help with healing.
C) Recovery & Aftercare
Immediate Post-op care: Drinking plenty of water is mandatory after surgery. Your dentist will also ask you to stick to a soft diet for the first few days. He will even ask you to avoid hot, spicy, and crunchy foods at the site. Physical activities like walking and going to the gym must be avoided.
Oral Hygiene: Gentle brushing of the site with the antibacterial mouthwash is advised to keep the site infectious-free. Sucking with straws must be avoided to prevent the dislodgement of the graft. Smoking should also be avoided.
Follow-up Appointment
Regular checkups with the dentist will ensure the healing process. Unresorbabale stitches are removed one week after surgery, while resorbable sutures will resorb independently.
Potential Complications
Infection: Bacterial infection can be common after surgery. Pre-procedural antibiotics cover decreases the risk of infection.
Graft Rejection or Failure: Sometimes, the body rejects the graft from external sources, especially if the markers on the graft aren’t identical to the host’s cells.
Pain and Swelling: Post-op pain is common, but it’s manageable with over-the-counter medications and prescription analgesics.
Nerve Damage: Your mouth is full of nerves. During incision and suturing, your nerve might get damaged, leading to numbness or tingling in certain parts of your mouth.
Bleeding: Excessive bleeding may be seen in patients with bleeding disorders. For this fact, your surgeon will recommend you stop taking some medications before the surgery
Frequently Asked Questions About Dental Bone Grafting
Who is the right candidate for bone graft surgery?
An oral maxillofacial surgeon will consider you as the right candidate for the surgery if:
- You have bone loss, which causes tooth loss and gum recession.
- You have active periodontal disease, affecting your appearance.
- You want a dental implant but don’t have enough bone to support it.
How much does a dental graft surgery cost?
It cost somewhere between $250 to $3000. You may ask your surgeon for an exact quote at your next dental visit.
The cost varies depending on the type of graft, the location of your dentist, and the extent of the procedure involved.
Dental insurance sometimes covers a partial cost of dental bone grafting, but you might need to pay a percentage share.
Can you smoke and drink after the surgery?
You’ll be advised to quit smoking two weeks before the surgery and two weeks post-surgery.
The nicotine in cigarettes are vasoconstrictors that constrict the blood supply to the surgical site, delaying its healing. This may put you at risk of dental infections and implant failure.
Also, alcohol is known to cause dehydration. This will negatively impact your oral health by delaying bone healing.
How early will you see results from bone graft surgery?
A natural or synthetic bone will take around six months to facilitate bone growth and regeneration. In case your bone graft fails, you’ll need multiple surgeries.
