Bone grafting for dental implants
Bone grafting may be necessary if there is insufficient bone at the site of the missing tooth to allow the planned implant to be placed in the correct position. By increasing the volume of bone, the procedure can create more favourable conditions for implant-supported tooth replacement.
During the implant consultation, we assess the need for bone grafting alongside the planned dental restoration. Based on this assessment, we can determine which procedure is appropriate and whether the bone grafting can be carried out at the same time as the implant placement or as a separate procedure.
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When might bone grafting be necessary?
Following the loss of a tooth, the surrounding bone undergoes remodelling, and its volume may decrease in the area where the tooth is missing. Periodontal disease, previous inflammation or injury can also affect the condition of the bone. For this reason, the size of the gap left by the missing tooth alone does not determine whether an implant can be placed.
When making this decision, we assess the planned dental restoration, the location of the implant and the surrounding anatomical structures. A different solution may be appropriate for a small local defect than for a more extensive bone defect.
Assessment and personalised planning
In addition to the oral examination, any available imaging scans must also be assessed. At Naturadent, the planning of bone grafting is aided by three-dimensional CBCT scans, which help to assess bone dimensions, the position of nerves and the relationship between the upper jaw and the maxillary sinus.
At the consultation, please tell us what medical conditions you have, what medicines you are taking, and whether you smoke. It is particularly important to mention, for example, diabetes, medicines that affect blood clotting, and treatments for osteoporosis. Do not stop taking any medicines on your own; any changes to your treatment will be discussed by your doctors.
Preparing for bone grafting
Please bring your previous dental X-rays and a list of the medicines you are taking to the consultation. If you use a removable denture, please mention this as well, as the pressure it exerts on the healing area needs to be taken into account. Please let us know if you have experienced unusual bleeding, prolonged healing or a drug allergy during any previous oral surgery.
Before the operation, please discuss the instructions regarding meals, medication and your journey home. These will also depend on the type of anaesthesia used; the preparations may differ depending on whether you are having a local anaesthetic, sedation or general anaesthesia. It is advisable to arrange your post-operative rest period and the date of your first follow-up appointment in advance to fit in with your work schedule.
Bone substitute materials and membranes
The procedure may be carried out using the patient’s own bone, processed human donor bone, animal-derived bone substitute or synthetic material. These options can also be combined. The bone substitute provides the space and framework necessary for new bone formation; it is not simply a filling material that sets immediately.
The choice of material is influenced by the shape and size of the defect, the surgical plan and your own preferences. The bone graft is often protected by a membrane, which helps to isolate the regenerating area from the soft tissues. Ask about the origin of the material and the membrane, particularly if you have any religious or personal reservations in this regard.
At Naturadent, sterilised, protein-free bone substitutes and collagen membranes of bovine origin are used. The specific material and the required quantity are determined by the individual treatment plan.
Minor and major bone grafting
For smaller defects, a granular bone substitute and a membrane can be applied to the affected area. For larger defects, a more complex reconstruction, such as a fixed bone block or another space-maintaining solution, may be required. Harvesting autologous bone may also require a separate surgical site.
In the area of the upper molars, a sinus lift may also be necessary due to the proximity of the maxillary sinus. This is a specialised procedure for increasing bone volume.
Bone grafting and implantation in one or two stages
Minor bone augmentation can be carried out at the same time as implant placement, provided the conditions are right. This requires sufficient existing bone and adequate initial implant stability.
In the case of a larger defect, the bone graft is prepared first, and implantation takes place once healing has occurred. The waiting period is typically measured in months and depends on the procedure, the material used and the healing process. The fact that the wound has closed on the surface does not yet mean that the bone can bear weight.
The bone grafting procedure and anaesthesia
The procedure can also be carried out under local anaesthetic; the appropriate method of anaesthesia will be chosen based on the extent of the operation and your condition. The dentist will expose the area to be treated, position the bone graft and secure it as necessary, and then close the wound.
The aim of anaesthesia is to eliminate surgical pain, but you may experience a sensation of pressure. Afterwards, you may experience pain, swelling and bruising. You will receive personalised advice from your doctor regarding pain relief and any medication you may need.
Protection of the area undergoing restoration
During the initial period, you must avoid injuring or putting strain on the surgical site. It is important to follow the instructions given regarding eating, brushing your teeth, rinsing (if necessary) and wearing removable dentures. Do not press on the wound, and do not attempt to remove the stitches or any visible material at home.
Smoking impairs wound healing and increases the risk of treatment failure. During the follow-up appointment, the condition of the wound is assessed, and subsequently the healing of the bone and the possibility of the next stage of treatment are evaluated. Proper cleaning and monitoring are also required later on to ensure the long-term maintenance of the implant and the dental prosthesis.
The expected healing time for the implant is 2–4 months without bone grafting; if bone grafting is carried out at the same time, this may take a further 1–2 months. This does not represent the total treatment time for bone grafting carried out as a separate operation, nor is it a guaranteed timeframe. The treating dentist will decide on the next step based on the follow-up examination. We also supplement bone grafting with a graft prepared from the patient’s own blood and laser biostimulation; the use of these is detailed in the treatment plan.
The successive stages of healing and tooth replacement
The first stage following surgery is wound healing. At this stage, it is important to monitor swelling, pain and the ability to keep the area clean, as well as to protect the surgical site. The dentist checks that the wound is healing properly and inspects the stitches. A reduction in symptoms may be a positive sign, but it does not in itself indicate how much new bone has formed.
In the next stage, the healing of the bone graft and the conditions for implantation are assessed. If the implant is scheduled for a separate appointment, the timing of the procedure is determined based on these results. In the case of simultaneous bone grafting and implantation, the healing of the implant must also be monitored.
The fabrication of the final crown, bridge or other implant-supported restoration is a further stage of treatment.
The first follow-up appointment takes place approximately one week after the operation. Stitches are removed in accordance with individual instructions, typically after 10–14 days. The patient receives an information and consent form, which also sets out the post-operative care instructions.
Possible complications and warning signs
Infection, wound dehiscence, displacement of the bone substitute or membrane, or inadequate bone formation may occur. In such cases, further surgery may be required. Depending on the surgical site and the bone graft, sensory disturbances may also develop.
If you experience increasing pain, a fever, discharge, a wound reopening or persistent bleeding, contact your doctor as soon as possible. Heavy, unrelenting bleeding, or difficulty breathing or swallowing, requires urgent medical attention.
Treatment and temporary dental restorations whilst healing
When you can return to work and sport depends on the extent of the operation, your symptoms and the nature of your work. Sedentary work and heavy physical exertion may require different assessments. When making plans, please let us know if you have an important event, a trip or a physically demanding task coming up; do not assume that you will definitely be able to cope with a full workload the very next day.
A temporary dental prosthesis may be an option in certain cases, but not all prostheses can be worn without modification following surgery. The prosthesis must not exert any harmful pressure on the treated area. You should only use your existing removable dental prosthesis in accordance with the advice given during your check-up and the instructions provided.
The cost of bone grafting and the alternatives
The cost of bone grafting depends on the size of the affected area, the procedure, the materials used and the surgical steps required. The quote will specify the fees for the bone graft, the implant and the final dental restoration separately.
If you do not wish to have a dental implant, or if this is not recommended, other types of dental restoration – such as a bridge or a removable denture – may be considered, depending on the results of the examination.
Frequently asked questions about dental bone grafting
Is bone grafting necessary for every implant?
No. It is only considered when there is insufficient bone volume or the bone shape is not suitable for the planned implant placement. The need for it must be assessed on the basis of the dental restoration plan and the examination.
Why isn’t it enough just to look at the site of the missing tooth?
The shape of the gum does not accurately reflect the dimensions of the underlying bone. For implant placement, the width and height of the bone, as well as its relationship to the anatomical structures, must also be assessed.
Is the bone graft always placed in the maxillary sinus?
No. Bone grafting may be required in various areas of the jawbone. A sinus lift is a specialised procedure carried out in the area around the upper back teeth, which has its own specific requirements and post-operative care guidelines.
Is autologous bone always used for bone grafting?
No. A variety of materials and combinations can be used. If an autologous bone graft is planned, the site of the bone harvest, as well as any associated symptoms and risks, will be discussed during the consultation.
Can the implant be inserted at the same time as the bone graft?
In certain cases, yes, provided that adequate initial implant stability can be ensured in the existing bone. In the case of larger defects, it is necessary to wait for the bone graft to heal first. The implantologist will decide on the timing.
How can you tell if the bone has healed?
The possibility of proceeding to the next stage can be assessed by means of a follow-up examination and, if necessary, a three-dimensional CBCT scan. The removal of stitches or the cessation of pain does not in itself prove that the area is ready to bear weight.
Will I be without teeth whilst I’m recovering?
At Naturadent, we also plan temporary tooth replacements, and we discuss the options for this before the operation. The solution depends on the location of the missing tooth and the surgical plan; protecting the healing area is our top priority.
When will I be able to go back to work or play sport again?
There is no set timeframe that applies to every operation. The implantologist will determine when you can return to normal activities based on the procedure and the strain it places on you. Do not resume sporting activities on your own, even if the wound is barely painful.
Can the success of bone grafting be guaranteed?
No. There is a risk of insufficient bone formation, infection or partial loss of the implant. The risk depends on your condition and the nature of the operation; a decision on the next steps can be made following an examination.
What should I do if I see foreign matter in the wound or if the wound reopens?
Do not attempt to remove or push back the material. Contact your doctor and ask for a check-up. It is particularly important to be examined as soon as possible if you have a fever, increasing pain or persistent bleeding.
Book an appointment
Book an appointment for an implant consultation. Based on the examination, we will discuss whether bone grafting is required and what treatment steps you can expect in your case.
I would like to book a consultation regarding dental implants
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