Can Implants be Done Without a Bone Graft? Is Grafting Really Needed?
Dental surgeons are asked this one all the time. Many of our patients are surprised to hear the answer. Most likely, no—you will likely not need to get a bone graft, should you elect to have dental implant surgery. There are some cases where a bone graft may produce a better result. Other examples where PRF can be used as a graft product in place of bone from a horse or cadaver as are usually used. But is it necessary to get a bone graft for a dental implant?
Bone graft situations are not created equal. There are really two different situations:
- bone graft aka guided tissue regeneration where there is not enough bone volume for an implant. In this situation, a procedure will need to be done to grow a volume of bone prior to surgically placing a dental implant. A necessary healing period for the bone graft of at least 3 months is necessary. After the graft healing period and implant can be placed after which there is an additional 2-3 month healing period.
- graft near the time of extraction where a dental implant is placed at the time or around the time of tooth extraction. During this immediate implant surgery or delayed implant surgery, the implant is surgically placed along with a bone graft to fill in any holes in the bone the implant does not fill. In this later case, the implant and graft heal at the same time in about 2-3 months.
- In cases where several teeth are being removed and several implants are being placed, grafting should always be performed. The grafts are performed to prevent tissue loss in the areas where teeth are removed and to help bone to grow properly around the implants. Complex full arch implants cases always requires some grafting to achieve optimal results.
Bone Grafts can be necessary to help tooth extraction sites heal properly
Grafts can be necessary in order to get extraction sites to heal properly. Grafting in extraction sites is also called socket preservation. Wisdom teeth and root canal extraction sites are notorious for having healing complications. Wisdom teeth are often times chronically infected prior to extraction and contain cysts. Wisdom teeth surgical sites can be difficult to reach and perform perfect surgical procedures. The sites are also difficult for people to keep clean and following post operative instructions can be difficult. Guided tissue regeneration techniques including bone grafts and platelet rich fibrin treatment are often used to help wisdom tooth extraction sites heal well. Basically when a tooth gets removed, a patient is sent home with a hole in their jaw bone (unless a graft is placed). A treatment such as PRF does a few things: 1) physically blocks gum tissue from growing into the jaw bone 2) helps protect the jawbone from bacterial infection. 3) provides building blocks to aid bone cells in growing new bone. When wisdom teeth extraction sites and other tooth extraction sockets are not managed properly, bone infections can persist for years. Many people believe chronic bone infections pose serious risk of medical problems.
Implant Dentists have always grafted for Implants haven’t they?
It is true that many dentists will add bone grafting material to an area before placing a tooth implant. This is an ‘old school’ approach that is still commonly done. In some cases, it’s still necessary to do a graft. The question is, “is there enough bone for placement of a new implant root?” This question can be very subjective and case by case or even site by site in the same patient’s mouth. For example, if a tooth does not have enough gum around it when they smile it will not look good. If the same tooth is a front tooth, the site will need a graft for cosmetic dentistry reasons. If the same tooth is a back tooth, the implant may not need anything because there are no cosmetic concerns. In this later example, there may be adequate bone for an implant and no need for bone augmentation.
Can Bone Grafting be Avoided?
In many cases, however, we see bone grafting as unneeded and expensive procedure that greatly slows down the process of tooth replacement. Thanks to new types of dental implant materials that are available, all we need to work with, in order to place a dental implant, is 4 mm of bone width in many cases.
In cases where there is not enough bone to work with, in order to successfully place a tooth implant, it is possible in some cases for guided tissue regeneration be necessary to make a site in the jaw more suitable for tooth replacement with implants. In cases where grafting is necessary, we use PRF or platelet rich fibrin which helps bone and implants heal stronger and faster. PRF is derived from the patients own blood and is a holistic dental procedure.
PRF can be used as a graft material or as a membrane or as a part of a bone graft mixture
Platelet rich fibrin is derived from patient blood draws. There are no added chemicals or other ingredients. The blood vials are placed in a centrifuge and spun for 13-15 minutes at 2700 – 3000 rpms. PRF is basically a mixture containing all the things necessary to prevent infections and rapidly heal and grow bone. Some of the things in PRF include platelets, white blood cells, stem cells, bone morphogenic protein and of course, fibrin. PRF can be used in combination with other graft products as a “super” bone graft of sorts. PRF can also be converted into a membrane and barrier to help hold bone graft materials.
Grafting ahead of implants adds healing time and may or may not be necessary
For patients who require bone grafting for teeth implants, placing Implants will take a little longer. In order to build up the jaw’s bone structure enough to support implants, part of the process involved may require waiting for a patient’s bone graft material to become properly integrated with the rest of their bone structure. This process may take months. So hopefully this sheds some light on if bone grafting is necessary for dental implants.
There are usually many possible approaches and strategies that an experienced implant dentist can take; for a more specific look at your case, please schedule a consultation with us.
Some root canal sites can be infected chronically. These sites can be very difficult to get to heal after extraction. Are root canals really necessary? Sometimes people experience regret about ever having gotten root canal procedures. Root canals can be necessary to save teeth or teeth can be removed and implants done instead.