Bone Grafting

WHAT IS BONE GRAFTING

A dental bone graft is a surgical procedure where bone or bone-like materials are used to rebuild or add volume to areas of the jawbone that have experienced bone loss. It adds volume and density to the jawbone, offering a stable foundation for dental implants or other restorative dental treatments.

WHY IS BONE GRAFTING NEEDED?

This procedure is typically necessary prior to a dental implant surgery or other jawbone surgeries, because an adequate amount of bone is required to securely anchor the implant. Many people have lost a tooth, which can lead to bone loss in the jaw.

Lack of Bone Volume

For a dental implant to be successfully placed, we need to ensure there’s an adequate amount of bone to support the implant. Bone grafting is used when the jawbone has insufficient height, width, or density.

Tooth Loss: Missing teeth can lead to bone deteriorate over time because it is no longer stimulated by the tooth root.
Periodontal Disease: Advanced gum disease can cause significant bone loss around the teeth.
Trauma or Injury: Accidents that damage the teeth and surrounding bone can result in bone loss.
Developmental Defects: Some individuals naturally lack sufficient bone in certain areas of the jaw.

Stabilizing the Implant

A solid foundation of bone is essential to stabilize the dental implant. Bone grafting helps provide this stable base, ensuring that the implant integrates with the bone (a process called osseointegration), leading to long-term success and functionality.

Restoring Facial Structure

Significant bone loss can alter the shape and appearance of a person’s face, leading to a sunken or aged look. Bone grafting can help restore and maintain the natural contours of the face by rebuilding the jawbone structure.

Supporting Surrounding Teeth

Bone grafting helps maintain the alignment and health of adjacent teeth. Without sufficient bone, neighboring teeth can shift or become loose, affecting overall dental health and functionality.

Preparing for Multiple Implants

In cases where multiple implants are needed, bone grafting ensures that there is enough bone to support each implant. This is crucial for procedures involving full arch replacements or complex restorations.

Ensuring Long-term Success

Bone grafting enhances the likelihood of long-term success for dental implants. Adequate bone volume helps ensure that implants remain stable and function properly for many years.

TYPES OF BONE GRAFTING

Bone grafts used in dental procedures can be categorized based on the source of the graft material. Each type has its own advantages and potential drawbacks. Here’s an overview of the different types of bone grafts:

Autografts

Autografts are bone grafts obtained from the patient’s own body, commonly from sites like the chin, jaw, hip, or tibia. They are considered the gold standard in bone grafting because they are highly biocompatible and contain living bone cells that promote faster and more effective healing.

However, the need for an additional surgery to harvest the bone increases the complexity and recovery time and introduces the risk of complications at the donor site, such as pain or infection.

  • Description: Bone grafts used from the patient’s own body.
  • Source: Commonly taken from the chin, jaw, hip, or tibia.
  • Advantages:
    • There’s no risk of immune rejection, promote faster and effective healing
  • Disadvantages:
    • Requires additional surgery to obtain the bone, increasing complexity and recovery time.
  • There’s Risk of complications at the donor site, such as pain or infection

Autogenous Bone

Autogenous bone grafts, also known as allografts, are bone grafts taken from human donors, typically cadavers, and processed for use in another person. They are sourced from tissue banks and offer the advantage of not requiring a second surgical site, reducing patient discomfort.

  • Description: Bone grafts used from the patient’s own body.
  • Source: Common donor sites include the chin, jaw, hip (iliac crest), or tibia
  • Advantages:
    • Biocompatibility: Since the bone comes from the patient’s own body, there is no risk of immune rejection.
    • Osteogenic Potential: Autografts contain living bone cells that can form new bone, promoting faster and more effective healing.
  •  Disadvantages:
    • Requires an additional surgery to harvest the graft, increasing the complexity and recovery time.
    • There can be pain, infection, or other complications at the donor site.

Allogenic Bone

Allogenic bone grafts are obtained from human donors, typically cadavers, and are processed using techniques such as freeze-drying to extract water and sterilize the bone. This processing ensures that the graft is safe for use in another person and eliminates the risk of disease transmission. Unlike autografts (bone from the patient’s own body), allogenic bone does not contain living cells that can generate new bone tissue. Instead, it acts as a framework over which the recipient’s bone can grow.

  • Description: A bone graft harvested from human cadavers and processed via freeze-drying to remove water.
  • Source: thigh bone, shin bone, hip (iliac crest), upper arm bone, or calf bone
  • Advantages:
  • No need for a second surgical site, reducing patient discomfort.
  • Readily available in various forms (powder, putty, chips).
  • Eliminates the risk of complications at a donor site within the patient.
  • Provides a structural framework for new bone growth from the surrounding bony walls.
  • Disadvantages:
  • Cannot produce new bone on its own (lacks osteogenic potential).
  • Slight risk of immune reaction, although rare.
  • Potential risk of disease transmission, minimized by rigorous screening and processing.
  • Generally lower osteoinductive potential compared to autografts, as bone cells are usually removed during processing.

Xenogenic Bone

Xenogenic bone grafts are derived from animals, with bovine bone being the most common source. These grafts undergo extensive processing to remove any organic components that might cause an immune reaction, ensuring they are safe for human use. The processed bone retains its structural integrity, making it an effective scaffold for new bone growth. However, since it lacks living cells, it cannot produce new bone on its own.

Because this option lacks autograft’s bone-forming properties, bone regeneration may take longer, and have a less predictable outcome.

  • Description: Xenografts are widely used in dental and orthopedic procedures due to their availability and ability to provide a structural framework for new bone growth without the need for harvesting bone from the patient.
  • Source: 
    • Long bones (like the femur or tibia), which provide a good quantity of dense, cortical bone.
    • Ribs and sternum, which can provide both cortical and cancellous (spongy) bone.
  •  Advantages:
    • Readily available and in large supply.
    • Structurally similar to human bone, providing a good framework for new bone growth.
    • Eliminates the need for a second surgical site within the patient.
  • Disadvantages:
    • Potential for an immune reaction, minimized through extensive processing.
    • Slower bone formation
    • Lacks living cells, so it does not have osteogenic properties.

BONE GRAFTING PROCEDURE

Bone grafting for dental implants and jawbone repair involves several steps. This is what you can expect when you schedule an appointment at our office:

  • Step 1: Initial Consultation:
  • Assessment: An oral surgeon at OFS Pittsburgh evaluates the patient’s dental and medical history, and conducts a thorough examination, including imaging studies to assess bone quality and quantity.
  • Treatment Planning: A personalized treatment plan is developed based on the patient’s specific needs and the type of bone graft required.
  • Step 2: Preparation Before the Procedure:
  • Health Evaluation: Ensure the patient is in good overall health.
  • Medications: The patient may be prescribed antibiotics to prevent infection and instructions for managing pain and swelling post-surgery.
  • Fasting: If general anesthesia or sedation is planned, the patient will need to fast before the procedure.
  • Preoperative Instructions: The patient receives specific instructions regarding oral hygiene and other preparatory steps to minimize the risk of complications.
  • Step 3: The Bone Grafting Procedure:
  • Anesthesia: Local anesthesia, sedation, or general anesthesia is administered to ensure patient comfort during the procedure.
  • Incision: An incision is made in the gum tissue to expose the area where the bone graft is needed.
  • Bone Graft Placement: The chosen bone graft material (autograft, allograft, xenograft, or alloplast) is carefully placed in the defect or area needing augmentation.
  • Membrane Placement: In some cases, a resorbable or non-resorbable membrane may be placed over the graft to protect it and promote proper healing.
  • Suturing: The gum tissue is sutured back in place to cover the graft.
  • Step 4: Postoperative Care:
  • Home care instructions: Your oral surgeon will share personalized home care instructions based on your specific needs.

Follow-Up Visits: Regular follow-up visits are scheduled to monitor healing and ensure the graft is fusing properly.

BONE GRAFTING TECHNIQUES

Different techniques are used based on the specific needs of the patient. Each technique aims to create a stable and sufficient bone structure to support dental implants and restore oral functionality and aesthetics.

The following techniques are used at OFS Pittsburgh:

Socket Grafting (Alveolar Ridge Preservation):

A socket graft is performed immediately after tooth extraction to prevent bone loss and preserve the socket from future implant placement.

Sinus Lift

A sinus lift, or sinus augmentation, increases bone height in the upper jaw, specifically in the area of the molars and premolars, to accommodate the dental implants.

Ridge Augmentation

A ridge augmentation Increases the width and/or height of the jawbone to provide a stable foundation for dental implants.

ARE BONE GRAFTS SAFE?

Bone grafting procedures are safe and have high success rates, especially when performed by experienced dental professionals.

Success Rates of Bone Grafting Procedures

Bone grafting procedures have high success rates, typically ranging from 90% to 95%. The success rate can vary depending on the type of graft used (autografts, allografts, xenografts, or alloplasts), the location of the graft, and the patient’s overall health.

Factors Influencing the Success of Bone Grafts

There are several factors that determine whether a bone graft will be successful:

Patient Health

  • General Health: Overall health, including the presence of chronic conditions like diabetes, can impact healing and integration.
  • Oral Health: Good oral hygiene and the absence of periodontal disease are crucial for graft success.

Graft Material

  • Type of Graft: Autografts have the highest success due to their osteogenic properties. Allografts, xenografts, and alloplasts are also effective but depend on processing and integration.
  • Quality and Quantity: Adequate volume and proper preparation of the graft material are essential.

Surgical Technique

  • Skill and Experience: The surgeon’s expertise plays a significant role in the success of the procedure.
  • Technique: Proper placement and stabilization of the graft are crucial.

Location of the Graft

  • Jaw Area: The success rate can vary depending on whether the graft is placed in the upper or lower jaw and the specific location within the jaw.

Postoperative Care

  • Compliance: The patient’s adherence to postoperative instructions, including oral hygiene, diet, and medication, significantly affects the outcome.
  • Follow-up Visits: Regular follow-up appointments ensure the graft is integrating as expected and allow for early detection of any issues.

Potential Risks and Complications

Bone grafting, like any surgical procedure, comes with potential risks and complications. Understanding these can help in managing expectations and preparing for possible issues.

Infection: Infection at the graft site is a potential risk since the mouth harbors bacteria. This is relatively uncommon due to sterile techniques and the use of antibiotics.

Graft Rejection or Failure: The body may reject the graft, or the graft may fail to integrate with the existing bone. This occurs in a minority of cases, more commonly with allografts and xenografts than autografts.

Bleeding and Swelling: Bleeding and swelling are common postoperative symptoms, but are easy to manage by following your surgeon’s home-care instructions. However, persistent or severe bleeding should be reported to the surgeon.

Pain and Discomfort: Pain at the graft site and/or the donor site (in the case of autografts) is expected. It is common but easily manageable with medication. Persistent or severe pain should be addressed with the surgeon.

Nerve Damage: Nerve damage can occur, leading to numbness, tingling, or loss of sensation, especially in procedures involving the lower jaw. It’s rare but more likely in complex or extensive grafting procedures.

Sinus Complications (for Sinus Lifts): There is a risk of sinus membrane perforation or infection. However, it is relatively uncommon with experienced surgeons.

Gum Tissue Recession or Dehiscence: The gum tissue over the graft may recede or fail to heal properly, exposing the graft. This is fairly uncommon though.

Resorption of the Graft: The grafted bone may resorb or shrink over time, reducing the effectiveness of the graft. This is dependent on the type of graft material and patient factors.

Long-Term Outcomes and Benefits

Bone grafts used in dental procedures offer many long-term benefits. These include improvements in both function and aesthetics, as well as the overall health of the jawbone and surrounding structures.

Improved Bone Volume and Density

  • Enhanced Support: Bone grafts provide a stable foundation for dental implants, ensuring they are securely anchored.
  • Restoration: They help restore bone volume and density, particularly in areas affected by tooth loss, disease, or injury.

Facial Structure Preservation

  • Aesthetic Benefits: By maintaining bone volume, grafts help preserve the natural contours of the face, preventing a sunken or aged appearance.

Enhanced Implant Success

  • Implant Stability: Adequate bone volume increases the likelihood of successful osseointegration of dental implants, leading to long-term stability and function.
  • Longevity: Properly integrated implants supported by bone grafts have a higher likelihood of lasting many years, if not a lifetime.

Functional Improvement

  • Chewing and Speaking: Bone grafts enable the placement of implants, which restore the ability to chew and speak properly, improving overall quality of life.

Prevention of Further Bone Loss:

  • Stimulation: Implants supported by grafted bone provide the necessary stimulation to the jawbone, preventing further resorption and maintaining bone health.

Cost and Insurance

Understanding the cost and insurance implications of bone grafting procedures is crucial for patients. Well-informed patients can better plan for their procedure and effectively manage their finances.

Average Cost of Bone Grafting Procedures

The cost of bone grafting procedures can vary widely based on several factors, including the type of graft material used and the complexity of the procedure. On average, patients can expect to pay between $300 and $3,000 per graft site. 

Autografts, which involve harvesting bone from the patient’s own body, tend to be more expensive due to the additional surgical procedure required. 

Allografts and xenografts may be less costly but can still range from $200 to $1,200. Advanced procedures like sinus lifts or ridge augmentation may increase the overall cost.

Insurance Coverage and Financing Options

Insurance coverage varies depending on the insurance provider and the specific policy. Some dental insurance plans cover bone grafting if it is deemed medically necessary, such as to support a dental implant. However, coverage for elective or cosmetic procedures may be limited. It is essential to check with your insurance provider to understand what is covered under your plan.

BOOK AN APPOINTMENT

You can schedule an appointment online or over the phone.