What is bone grafting?
In cases where the jaw bone has severely resorbed, dental implants would have to be placed in anatomically unfavorable positions to make sure that enough bone surrounds an implant, to provide a solid foundation [1]. To avoid this scenario, a dentist may consider it a better option to increase the width and height of the jawbone before placing the implant. This is called bone grafting. When a bone graft is performed on the upper jaw, it is known as a sinus lift.
There are different bone grafting materials available. Each material type has its own specific indications, strengths, and weaknesses. A bone graft can either contain bone matter harvested from your own body, from a human donor, from an animal or be of a synthetic nature.
It’s important to remember that not everyone needs a bone graft for dental implant treatment. It is only performed when you have an insufficient volume of bone.
Continue reading to discover:
How does bone grafting work?
Bone grafting (Fig. 1) can be performed at different stages of dental implant treatment. It can be performed prior to implant insertion (a two-stage approach) or on the day of the dental implant placement (a one-stage approach)[2][3][4][5].
A bone graft does not only replace the bone that has been lost but stimulates the growth of new bone. Unlike dental implants, bone grafts are meant to disappear over time and be replaced by the bone cells from your body. Depending on the quality of the bone graft material, the bone graft can be replaced fully by your own cells. This process can take anywhere from three to nine months.
Bone grafts may require the use of an overlying membrane that provides a barrier between bone and gingival tissue to enable an unimpeded formation of new bone[6]. The membrane also holds the graft material in the desired shape, and location while the bone heals. Such membranes are either resorbed after a few months or can be long-lasting.
How do you know if bone grafting was successful?
The performance of bone grafting materials is determined by their function to stimulate and support bone repair (a process known as osteoconductivity)[7]. There are many additional factors that could influence the success of a bone graft, such as the presence of bacteria, inflammation, or infection at the site. It will take some time after the bone grafting has been performed to see how successful the procedure really was. Most importantly is the density of bone after the healing period of around three to six months, considering both the density of the so-called ingrowth bone, which is the bone surrounding the dental implant, and the total bone density once the graft has fully resorbed.
[2] Schliephake H, Dard M, Planck H, Hierlemann H, Stern U. Alveolar ridge repair using resorbable membranes and autogenous bone particles with simultaneous placement of implants: An experimental pilot study in dogs. Int J Oral Maxillofac Implants 2000;15:364-373.
[3] Cordaro L, Amade D S, Cordaro M. Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant placement. Clin Oral Implants Res 2002;13:103-111.
[4] Artzi Z, Nemcovsky CE, Tal H, Weinberg E, Weinreb M, Prasad H, Rohrer MD, Kozlovsky A. Simultaneous versus two-stage implant placement and guided bone regeneration in the canine: Histomorphometry at 8 and 16 months. J Clin Periodontol 2010;37:1029-1038.
[5] Chiapasco M, Casentini P, Zaniboni M, Corsi E. Evaluation of peri-implant bone resorption around Straumann bone level((c)) implants placed in areas reconstructed with autogenous vertical onlay bone grafts. Clin Oral Implants Res 2012;23:1012-1021
[6] Sanz-Sánchez I, Ortiz-Vigón A, Sanz-Martín I, Figuero E, Sanz M. Effectiveness of Lateral Bone Augmentation on the Alveolar Crest Dimension: A Systematic Review and Meta-analysis. J Dent Res 2015 Sep;94(9 Suppl):128S-42S. doi: 10.1177/0022034515594780
[7] Kolk A, Handschel J, Drescher W, Rothamel D, Kloss F, Blessmann M, Heiland M, Wolff K-D, Smeets R, Current Trends and future perspectives of bone substitute materials – From space holders to innovative biomaterials. J CMF Surg 2012;40:705-718.