Will I Need a Bone Graft Before I Get Dental Implants?

This is a great question, and one that you should consider if you have a missing tooth. Often, we surprise people with the news that, in order to replace their missing tooth or teeth with dental implants, they will require a procedure to rebuild lost bone. At Designer Smiles, our goal is always to provide excellent dental treatment with long-term success.

With our many years of experience in replacing missing teeth with dental implants, we understand exactly what it takes to achieve long-term success. One of the requirements for a successful dental implant is an adequate amount of healthy jawbone in both the height and width dimensions. In many cases, people who have been missing teeth for years do not have adequate bone to support an implant due to significant bone loss.

Why Do I Have Bone Loss?

Bone loss is, unfortunately, a natural process in both the upper and lower jaws when a tooth is missing. The jawbone, known as alveolar bone, exists for one purpose, and that purpose is to surround and support teeth for chewing. The presence of teeth roots in the jawbone maintains the height and width of the bone itself. Of course, this bone can suffer damage from periodontal disease while the teeth remain in the jawbone, but that is a different story altogether. The type of bone loss we are describing is not a disease process, but a natural process.

After the loss of a tooth, the bone in the extraction site slowly begins to shrink over time. This bone loss typically occurs horizontally first, causing the width to narrow. Then it will also begin shrinking vertically. This leads to a short, narrow section of bone that is not large enough to surround a dental implant.

How Much Bone Loss is Too Much?

There are two factors influencing the necessary dimensions of bone for a dental implant. The first is the length and diameter of the proposed dental implant. Dr. Ann selects the specific size of your dental implant based on multiple aspects of long-term success. The size of the implant must correlate to the size of the tooth you are replacing. You cannot replace a large molar in the back of the mouth with a short, skinny implant. Longer lengths tend to produce higher long-term success rates in dental implants, too.

The next factor affecting the need for bone is the minimum requirements for healthy bone surrounding the dental implant. In order for an implant to heal and function successfully, it must be completely surrounded by jawbone. Ideally, you need several millimeters on all sides, including the spaces between adjacent teeth and approaching vital anatomical structures like nerves in the jawbone.

What is a Bone Graft?

A bone graft is a surgical procedure in which your dentist augments the width and/or height of the jawbone. This augmentation typically includes the addition of graft materials that stimulate natural bone growth. A bone graft can occur at the same visit when your dentist extracts a tooth (which slows down the natural bone loss process), at the same visit when she places the dental implant, or at a separate surgical visit before implant placement. These variables depend on your unique situation and the amount of bone you need to support your implant.

It goes without saying that the more bone loss you experience, the larger your bone graft will be. This does correspond to both size (the dentist will need to add more graft material when there is more bone loss) and invasiveness of the surgery.

Where Does Bone Graft Material Come From?

One concern we hear patients express is regarding the material we use for the bone graft. The good news is that you have options. We can graft a wide variety of materials into the jawbone. Some bone graft material is synthetic, made in a lab. Others originate in animal bone, most commonly cows and sheep. In these instances, all organic matter has been removed, and it is just inorganic matrix remaining in the graft material. Some choose to use human cadaver bone, and still others opt for their own bone, harvested from a different region of the body.

The factors that go into deciding which bone graft material is best include any cultural or religious considerations, the potential for rejection, and the risks of additional surgical sites (as in the case of using your own bone from another area of the body). Dr. Ann is a bone grafting expert, and she will be happy to walk you through this decision.

What is the Process for a Dental Implant that Requires a Bone Graft?

The process for bone grafting in the jaw varies depending on when the procedure occurs. As we mentioned earlier, Dr. Ann can perform this procedure in conjunction with either the tooth extraction or the placement of the dental implant. In both of those cases, the patient is largely unaware that anything additional is occurring. You would already be numb for the extraction or implant, and you would feel nothing unusual or “extra”. Most grafting material is relatively granular, so you might feel small pieces of a sand-like substance in your mouth throughout the healing process.

If a bone graft is necessary as a separate surgical procedure, you may experience some pressure sensations, but you will feel no pain. You will receive specific instructions from your surgeon to care for the surgical site and stitches covering it. The great news is that our jawbones do not have many sensory nerves, so the aftermath is not particularly painful. After a healing period, your surgeon will confirm that your body has accepted the graft material and formed a healthy bone site for your dental implant.