Bone grafting

What it is

A bone graft places material in the jaw where bone is missing. The graft works like a scaffold: over time, your own bone grows into it and replaces it. The material can come from:

• Donor bone from a tissue bank, screened and processed for safety
• Animal bone, usually from cows, processed so only the mineral frame remains
• Synthetic material made in a lab
• Your own bone, usually taken from another spot in your mouth

If you have personal or religious concerns about donor or animal material, tell your dentist. Other options are often available.

Some grafts are small, such as filling a socket right after a tooth is removed. Others are larger, such as rebuilding a thin jaw ridge or adding bone under the sinus (the air space above your upper back teeth). Larger grafts are often referred to an oral surgeon or a periodontist (a dentist with extra training in gum and bone surgery).

Who it helps

You may need a bone graft if:

• You’re planning an implant and the bone is too thin or short to hold it
• You’re having a tooth removed and plan to get an implant later
• You’ve lost bone to gum disease, an infection, or an injury
• You’ve worn a denture for years and the bone under it has shrunk

Much of the shrinking happens in the first months after a tooth comes out. That’s why a graft is sometimes placed at the same visit as the extraction.

What happens

1. Exam and imaging. Your dentist takes X-rays, and sometimes a 3D scan, to measure the bone and plan the graft. You’ll talk about which graft material to use.
2. Numbing. We numb the area, which feels like a pinch and then a heavy numbness. If you’re nervous, ask about sedation options.
3. Placing the graft. If a tooth was just removed, the graft goes into the empty socket. Otherwise, a small opening is made in the gum, and the graft is placed against the bone. You’ll feel pressure, but the area stays numb.
4. Covering and closing. A membrane (a thin protective sheet) is often placed over the graft, and the gum is closed with stitches. You may feel a light tugging as they go in.
5. Healing. Over the next few months, your body replaces the graft with new bone. Then the implant can be placed.

Recovery and aftercare

Expect some soreness and swelling for a few days, and ice your cheek on the first day. If you’re given antibiotics or a rinse, use them exactly as directed.

While it heals:

• Eat soft foods and chew on the other side.
• For the first day, don’t rinse hard, spit, or use a straw. Don’t smoke.
• Don’t press on the area with your tongue, or pull your lip out to look at it.
• Wear a denture or temporary tooth over the area only as your dentist advises.

Call the office if bleeding doesn’t slow with pressure, or if swelling gets worse after the third day. Also call if you have a fever or a lot of graft material comes out.

Cost and insurance

The cost depends on the size of the area, the graft material, any imaging, and whether a membrane is used. It also depends on whether the graft is done with an extraction or on its own.

Coverage varies a lot. Some dental plans cover a graft tied to a covered extraction or implant, and many don’t. Financing can spread the cost; see insurance and financing.

Alternatives

• A bridge or a denture. If you choose a bridge or a denture instead of an implant, you may not need a graft. These don’t stop the bone from shrinking, though.
• A different implant plan. Sometimes a shorter or narrower implant, or one placed at an angle, can use the bone you have.
• Waiting. You can put off a graft, but the bone usually keeps shrinking, and a later graft may need to be larger.