Bone Augmentation

For implants to be placed it is necessary to have enough bone in your jaw for the implant to be placed and for osseointegration to take place. Tooth loss and bone regression are very much related, so it is common that implant candidates do not have sufficient bone for placement. Tooth loss will result bone wearing away and periodontal disease causes a deterioration in bone quality and subsquent tooth loss.


Where a patient lacks sufficient bone in the recipient site, bone augmentation is a process designed to create additional bone in which dental implants will be placed. There are many different types of bone augmentation procedures but generally they involve grafting the patients bone, third party bone or a synthetic substitute to the jaw.


Your implant specialist will advise you on the best procedure for you taking into account the type, location and number of implants to be used. Make sure your dentist explains all your options thoroughly. After bone augmentation, it will take several months for the grafted materials to fuse with your jaw. It will usually take from 4 to 12 months before implants can be placed.


Often patients have strong opinions about the source of the grafted bone. Make sure to discuss this with the surgeon before proceeding with the operation. Bone grafting materials can be taken from the following sources:


  • Bone harvested from your own body is probably the best material for bone augmentation. This is known as an autogenous bone graft and tends to provide better results than other sources. Bone is typically taken from your chin or the back part of your lower jaw (ramus). If there is not enough bone in either of these places, bone can also be taken from your hip or shin bone (tibia). The disadvantage with this type of procedure is that it is a two stage operation as the bone needs to be extracted first and subsequently placed. Bone taken from the hip will require a hospital stay.
  • Bone can also be harvested from human cadavers (called “allografts”) or animals (called “xenografts”).
  • Synthetic materials also can be used for bone grafting.  Newer products, such as bone morphogenetic protein-2 (BMP-2), also are available. BMP-2 stimulates certain body cells to turn into bone, without grafting. This protein occurs naturally in the body.  The dental material is produced using DNA technology.


The success rate for bone grafts in the jaws for the purpose of placing dental implants is very high. However, you should discuss your options and their risks and benefits with an implant specialist before any procedures are done.


Colgate have given the following example of a bone grafting operation on its website:


“In a typical situation, a patient has lost a single tooth and wants to have it replaced with a crown supported by a dental implant. However, the tooth has been missing for several years and there is not enough bone to support the implant. In this case, bone taken from the patient’s chin or from a cadaver can be used to “rebuild” the lost bone so that it can support an implant. This type of procedure is done in the surgeon’s office.


Local anesthesia will be used to numb the area where the bone augmentation is needed (recipient site) as well as the area from where bone will be removed (donor site). An incision (cut) in the gum where the implant will be placed is made to determine how much and what type of bone is needed.


If the bone is taken from the chin, then the surgeon will make a cut in the gum below the lower front teeth to expose the chin bone. A block of bone will be removed from the chin along with any bone marrow. Many dentists fill the spot where the bone was removed with another type of bone-graft material. They may cover this with a thin film of tissue to keep gum tissue from filling the space as it heals. The incision is then closed with stitches.


The block of bone that was removed from the chin will be anchored in place with small titanium screws. A mixture of your bone marrow and some other bone-graft material may then be placed around the edges of bone block. Finally, the surgeon may place a membrane over the graft and close the incision.


After a bone augmentation procedure, you will be given antibiotics, pain medicine and an antibacterial mouthwash. You will be asked to avoid certain foods. You also will be told how to avoid putting pressure on the area while it heals. If you wear a denture, you may not be able to wear it for a month or longer while the area heals. If you have natural teeth near the bone graft, your dentist may make a temporary removable bridge or denture to help protect the area.


The bone graft will take about six to nine months to heal before dental implants can be placed. At that time, the titanium screws used to anchor the bone block in place will be removed before the implant is placed.”

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