Are Bones Grafts Needed for Implants
Bone grafting is sometimes necessary to get a dental implant but not always. It depends on whether or not there is enough bone to support a replacement implant root. Think of an implant as a root replacement and bone as what holds the root into the mouth. If there is not any bone, there will be a loose tooth or implant. It is that simple. If you have enough bone to support an implant, then all you need is an implant and not a bone graft.
But it may not be that simple. There are different situations where a bone graft is necessary. There are also other reasons why a graft may be necessary or advisable. “Advisable?” Some bone surgeons have different approaches to regenerating and building bone too. In a given situation, one surgeon may do a graft while another may not do a graft. Often times the end result is the same. So when is a graft really necessary?
Biological Bone Grafting Protocol:
Basically materials and techniques used either stimulate bone cells to grow – osseoinductive. Or materials placed will act as a temporary bone filling material that will be slowly dissolved and replaced with bone cells – osseoconductive.
The best bone grafting technique for bone regeneration is to use a combination of osseoinductive and osseoconductive materials. Or simply put, a mixture of bone factors that repair defects in bone and stimulate bone cells to grow. For this purpose, we use a biological bone graft protocol:
- completely extract any tooth fragments or foreign materials such as pieces of filling material or metal, so only bone and gum tissue remain
- remove any cyst or irregular scar tissue so only bone and gum tissue remain.
- use oxygen and dental ozone gas to kill bacterial and fungal infections in the pores of the bone.
- access the size and shape of bone defects
- place a mixture of platelet rich fibrin (PRF) and if needed a bone grafting material (generally we will graft any defects larger than 3-4mm)
- place PRF and collagen membranes as needed to hold graft products into place.
- suture gum tissue into place so it is not loose and closed if at all possible. Membranes will also block gum tissue from growing down into the healing graft or bony holes where it does not belong.
Biological Bone Graft and Sticky Bone Video:
Different Bone Grafts used in Implant Dentistry?
How to know if you need grafting. If you have:
- a simple hole in the bone such as an area where a tooth has been removed. Bone defect where there is no damage beyond the tooth extraction site. This is referred to as a “simple vertical bony defect” that is a simple hole down into the bone that has 360 degrees of bone surrounding it. Imagine a water glass that can be easily filled with graft material. The best example of this kind of defect is a tooth extraction site.
- a volume of bone damage where a large eaten-away volume of bone needs to be repaired. Imagine a water glass where a side or more of the glass has been broken off. The glass can no longer be easily filled. This bone defect is categorized by the number of bony walls missing and the amount of lost bone. This second more complicated bone loss needs a “block bone graft” and is a lot more complicated to repair. The use of a more expensive putty-like graft material and a membrane is necessary to perform this later kind of graft. The best example of this bone damage is a tooth extraction site where infection has spread from the tooth and eaten away a volume of bone surrounding the tooth. Sometimes bacteria can eat holes in the bone and into sinuses or out the cheek side or tongue side of the jaws.
- an area where a volume of bone has been lost and there is no hole or “defect.” There just is not enough bone to put an implant root into. These can be the most difficult if not sometimes impossible bone regeneration cases. Basically to grow bone where there is not any. Good luck, but it can be done.
Different Kinds of bone graft materials
- synthetic material
- human bone collected from the patient. This called an autograft
- human bone collected from a cadaver. This is called an allograft
- animal bone. Xenograft is what this graft is called.
- PRF or platelet rich fibrin bone stimulation procedures
- Or a combination of all the above
PRF is the only Biological Bone Graft Material
All the above materials are osseoconductive not osseoinductive except PRF. That is why PRF is called the biological bone graft material. Because it literally stimulates bone cells to grow more bone. PRF contains high concentrations of bone growth factors called bone morphogenic protein or BMP. BMP is the bodies signal to turn on bone growth. PRF is a very versatile material because it can be used as a graft material or a membrane.
Do I need a bone graft to get a dental implant?
Possibly. You will need to be evaluated by an implant dentist. You will need to take a 3D conebeam X ray to determine if you have enough bone volume to get a tooth implant. If you do not have enough bone to stabilize an implant, then you will need a bone graft.
Full Mouth Implant Cases:
Cases where many teeth are being removed and many implants are being placed will certainly need bone grafts. Such as complete full mouth dental implants. Some full implant cases can be designed to avoid a lot of expensive time consuming bone grafting. All on 4 dental implants is an approach to fixed permanent implants where a full set up teeth can be placed onto 4-6 dental implants. The strategy is to place the implants where there is bone and avoid sites where more difficult bone work is needed.
Do I need a bone graft in a tooth extraction site?
If you like to replace the tooth with a dental implant in the future, it is advisable to get a bone graft to preserve bone and prevent bone loss. The best time to get a dental implant is usually at the time of tooth removal. Sometimes immediate dental implant surgery is not possible due to pain, swelling and infection. A delayed implant surgery is an implant 1-4 weeks after tooth removal when infection makes immediate surgery impossible.
Does bone grafting work well?
Yes, especially with new novel platelet rich fibrin PRF bone procedures.
How Much does a bone graft cost?
anywhere from $400 – $3000 dollars. It depends on the size, shape and the health of the bone remaining. Sometimes where bone is very little and near the sinus, grafting can be very difficult with sinus lift bone graft surgery and expensive.