Bone grafting
Bone grafting is a surgical procedure that replaces missing bone to repair bone fractures that are extremely complex or increase the amount of bone in a particular site for various reasons.
In dental implantology, bone grafting is necessary when there is a lack of bone. For an implant to osseointegrate, it needs to be surrounded by a healthy quantity of bone.

dental implant surrounded
by healthy bone tissue
While there are always new implant types and techniques to allow compromise, a general treatment goal is to have a minimum of 10 mm in bone height and 6 mm in width.
Bone loss causes
The bone is lost through a biological process called bone resorption. Many reasons can cause excessive bone loss:
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Long-term teeth loss
When natural teeth are lost, the sites that remain after the extractions begin a remodeling process. Over time, the toothless areas will gradually lose height and width.
mandible bone recession after teeth loss
The bone resorption process occurs when toothless areas remain unrestored. The amount of bone loss is significantly reduced when a dental prosthesis is designed to restore the toothless gap, especially if dental implants support it.
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Periodontal disease
Periodontitis (or advanced periodontal disease) is a destructive disease involving a significant resorption of the alveolar bone tissue. If left untreated, it can lead to the loosening and subsequent loss of teeth.
progression of periodontal disease
When teeth are lost through periodontal disease, the bone left behind has already diminished significantly in height and width. An implant procedure in these circumstances is highly challenging.
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Bone disease
Various bone diseases, such as bone infections, osteoporosis, fractures, tumors, or following surgical interventions or radiation therapy, can stimulate the process of bone resorption, which results in a high amount of bone loss.
Surgical procedure
Various bone grafting techniques have been developed to achieve adequate bone width and height. Typically, the bone defects are filled with grafting materials, which are then covered with a semi-permeable membrane.

During the healing phase, natural bone replaces the graft, forming a new bony base for the implant and adding volume to the bone. The process is called guided bone regeneration (GBR).
Grafting materials
There are two types of grafting materials:
Autograft: natural bone harvested from large body sources, such as the iliac crest, the back of the head, or others.
Allograft: artificial substances that replace human bone and stimulate natural bone formation, such as calcium sulfate or hydroxyapatite.
Techniques
Three standard procedures involve bone grafting: sinus lift, lateral alveolar augmentation, and vertical alveolar augmentation.
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Lateral alveolar augmentation
Lateral alveolar augmentation is the increase in the width of a site. The procedure may be performed both at the upper and lower jawbones.
Whenever the bone width is insufficient, it is advisable to resort to these procedures, which are relatively simple, painless, and with an excellent success rate.
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Vertical alveolar augmentation
Vertical alveolar augmentation is the increase in the height of a site. The procedure is crucial if bone height is insufficient; dental implants placed in deficient bone have a high risk of failure.
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Other techniques
Other, more complex procedures also exist for sizable bone defects. These are performed under general anesthesia by the oral surgeon.
For example, the mobilization (or repositioning) of the inferior alveolar nerve (located inside the mandible) is indicated when the nerve has an abnormal position that does not allow proper placement of the implant fixtures.
The final decision about which bone grafting technique will be performed is based on assessing the degree of vertical and horizontal bone loss: mild, moderate, or severe.
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