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Bone grafting


Last Updated: 10.01.2024

Author: George Ghidrai, MD  

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

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:

  • 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 loss

    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.

  • 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

    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.

  • 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.

guided bone regeneration

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:


Techniques

Three standard procedures involve bone grafting: sinus lift, lateral alveolar augmentation, and vertical alveolar augmentation.


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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