do I need a bone graft Archives - Holistic and Biological Dentistry

Is it necessary to get a bone graft for a dental implant?

Are bone grafts needed to get implants? It is necessary to get a bone graft approximately 60% of the time when getting dental implants. It may or may not be necessary to get a bone graft for a dental implant. Whether or not a bone graft is necessary depends on two things:

If there is jaw bone damage that needs to be repaired prior to getting a dental implant
If there is not enough volume of bone available to get an implant, the implant cannot be placed prior to growing new bone.

Different Types of Bone Grafts:

There are many situations where bone grafts can be necessary. Below we review the common sites where bone grafting is often necessary.

Extraction site or “Socket Preservation”

If a tooth is extracted there will be a tooth extraction site that needs to heal and fill-in with bone prior to or at the same time as getting an implant. The decision to do or not to do a bone graft comes down to whether or not a graft will become necessary to get adequate bone to heal around an implant. Let’s take the example of a large molar tooth extraction site where the tooth extraction site is 8-12mm wide and perhaps 13mm deep in bone. With a large bony hole such as this extraction site, it will be nearly impossible to place a molar dental implant because the average size molar implant is 5-7mm wide by 10-12mm deep. The implant will literally be swimming in the extraction site and will not be placed intro any bone. In this case, the dental implantologist will need to place a bone graft into the extraction site and wait 3-4 months for the patient to grow bone and fill the bony defect with new healthy jaw bone.

Bone Graft to repair bone loss due to a tooth abscess

Tooth Abscess destroys bone that needs to be repaired and heal. Bone abscesses can be a very difficult to repair with a bone graft. root canal failures can be the biggest cause of bone abscesses. It is very difficult to predict how long and how many procedures may be necessary to repair bone caused by a dental abscess. Generally speaking, how long it can take to get a implant after a tooth abscess is determined by the size a shape of the bone damage. Other factors are the patient’s health and the health and quality of the remaining bone.

In some cases it can be difficult if not impossible to get an implant after a tooth abscess caused by a root canal. In the event of an abscess, it usually takes 6 months to get an implant. One bone graft procedure will be necessary to do a bone graft, 3-4 months to heal and another 2-3 months to place and have an implant heal.

Delayed bone graft weeks after tooth extraction

In some cases of tooth abscess, the root canal tooth or abscessed tooth may need to be extracted in one appointment and the bone graft may need to be done weeks later after a terrible acute draining infection has subsided. In cases of severe infection and bone loss, there also may need to be multiple bone graft procedures performed to gain enough bone for dental implant surgery. As you can understand, bone factors where there has been dental abscess and bone loss can be very unpredictable, time consuming and without guarantee.

Block bone graft to rebuild bone width and/or height

Bone loss related to tooth loss years ago. The problem here is there may not be enough bone volume to perform dental implant surgery. In these cases, a volume of bone will need to be grown prior to placing a dental implant. This is called a block bone graft or quadrant graft. In most cases, bone grafting can be performed with a 3-4 month healing period prior to getting a dental implant. Of course once there is adequate bone, implants can be done which require a 3-4 month healing period. Sometimes dental implants can be done at the same time as placement of the dental implants, cutting the time to as little as 3-4 months. The healing time depends on how much bone needs to be grown, the health of the patient and the quality of the patients bone where the bone graft is being performed.

Bone regeneration after loss from periodontal disease

Bone loss from periodontal disease / gum disease. Gum disease is a disease of the connection between the teeth and the jaw bone. In many cases no matter what is done in the way of teeth treatments, the teeth may be lost in the event of periodontal disease. In cases of moderate to severe gum disease, it is best to remove the teeth prior to losing all the bone around the teeth. Once to the bone is lost it is a lot more difficult to replace it. The key is to remove the teeth prior to losing all the bone. Once the teeth are removed and bone grafting is done, the gum disease process and associated bone loss will stop (because the cause of the bone loss-the teeth- is gone).

Bone grafts and Implants with Periodontal Disease

The key with gum disease is to get the teeth out as quickly as possible and implants placed, so you don’t end up spending a lot of time and money and dental procedures doing bone grafting. Theses cases can be very difficult to decide to act on because removing your teeth is a difficult decision to make but people who lose all their teeth to gum disease usually wish they had acted more quickly. Especially when they are sitting through several bone graft procedures and waiting long periods of time to get dental implants. Additionally once bone is lost, it is difficult to replace and you never get all the bone back.

Bone grafting for implants can be challenging

The key is to manage tooth loss with immediate or near immediate replacement of a natural tooth with an implant. If a tooth is replaced prior to any bone being lost, most of the time there will not be any bone loss and that is the key-to never lose bone by keeping teeth be they natural or implants in the mouth. Where we get into to trouble is teeth over-staying their healthy stay in the mouth or teeth being lost and not replaced in a timely fashion.

Chronically Infected sites can be difficult to bone graft

Extra care and attention should given to teeth with a great amount of infection. Such infections exist in root canals and cases of gum or periodontal disease. But are bone grafts necessary to get a dental implant? It depends on if there is enough bone width and height to place a dental implant successfully. Sometimes it is not necessary to get a bone graft for a dental implant, but doing so will improve the result of the implant result.

Bone Grafting with Platelet Rich Fibrin

Bone grafting techniques have come a long way. Platelet Rich Fibrin or PRF with bone grafting and more advanced and safer bone graft products have made bone grafting a lot more successful and predictable.

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But are bone grafts necessary to get a dental implant? Best thing is to get the opinion of a couple different implant dentists, but you may not know for sure till the day of implant surgery when there will either be enough good bone or not.

What happens if you don’t get a bone graft?

A bone graft is necessary if there is a hole in your jaw (extraction site) from having a tooth taken out. What happens if you don’t get a bone graft is gum tissue will grow down into the jaw and the bone will not heal properly. The gum tissue can stay living in the jaw for years along with bacteria, viruses and fungus. Dentists call this bone pathology. The areas of bone “pathology” or infection can contribute to systemic disease. And infected bone is not suitable for dental implants. Bone grafts add more expense, but in the long run it will save your health and save you from more expensive bone grafting and bone pathology treatments in the future.

Do you need to get a bone graft for an Implant?

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?

Needed implant bone graft

Dr. Adams does full arch implant cases every day. He will do your entire case including the oral surgery and fitting the teeth. It is important to have an experienced implant surgeon because problems with implants can occur. We also offer sedation if you who would rather be put to sleep for implants.

Dr Gary Adams

What are the types of bone graft procedures

Block bone graft with membrane. This is a 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 the implant can be installed after which there is an additional 2-3 month healing period prior to getting the implant tooth.

Socket preservation or bone graft of an extraction site with implant surgery. Bone 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.

Ridge preservation bone graft with multiple extractions and implants. 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 preserve bone and prevent infection

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.

Are Bone Grafts Needed for Implants?

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 has many uses in Bone Grafting and Implant Surgery

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.

PRF in Dental Bone Grafting Video

Grafting before implants adds healing time

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.

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Are bone grafts needed to get implants?