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A bone graft is a procedure that adds new bone material to a location in your mouth to repair or rebuild bone. It is typically recommended to re-establish the proper amount and shape of bone necessary to support your natural teeth or prepare the area for tooth replacement procedures.

Bone grafts are recommended for many reasons:

• If you have lost tooth-supporting bone from periodontal disease.
• To restore lost bone (or to prevent further bone loss) due to bone resorption following tooth removal or another cause of tooth loss.
• To re-establish lost or missing bone in advance of a dental implant. Your existing bone may not be sufficient to place or support the implant.
• If you are replacing a missing tooth with a bridge, and the bone and/or gum tissue have resorbed significantly. A bone graft can help the soft tissue in the area return to a healthy state so that the replacement tooth will not look abnormally large.
• To help restore tooth-supporting bone damaged as a result of injury.
• If your jawbone or tooth-supporting bone has not developed properly.

The names of bone grafts reflect the type of bone or bone-like material used.

• Autograft: a graft using your own bone, usually taken from the back of your jaw, chin, hip, lower leg bone, or elsewhere in your body.
• Allograft: a graft using human bone obtained from a tissue bank.
• Xenograft: a graft using bone from an animal source.
• Alloplast: a graft using a synthetic or plastic material.

Your dentist will explain the pros and cons, including any potential risks of each type of bone graft material and which one would work best for you. Your dentist may not perform all types of bone grafts and may refer you to an oral surgeon or periodontist.

Some advantages of bone grafts include:

• Preserving or restoring the bone's natural shape and structure.
• Increasing bone density, which may increase a dental implant's stability following placement. Increased bone density may also slow the bone resorption process. This is important if a significant amount of time elapses before your dentist can replace the missing tooth with a dental implant or bridge.
• Allows your dentist to place a dental implant into a location that would not have been possible without a bone graft.

Before the procedure

• Antibiotics: Your dentist may prescribe antibiotics before the bone grafting procedure to minimize the likelihood of developing an infection.
• Review your health status: You will share information that will help ensure that your dentist and their staff can provide safe and effective treatment and provide appropriate post-care guidance. Get important information here: Health history and current health status.
• Treatment review: Your dentist will describe the intended goals of the procedure. It is important to prioritize and communicate your expected treatment goals in advance of the procedure to ensure you and your dentist understand what you expect.

During the procedure

Specific bone grafting procedures have different steps. They are described in the links below. The process for your bone graft may vary, and you should discuss specific details with your dentist.

• Socket graft: To minimize bone resorption immediately following tooth removal.
• Block graft: To widen narrow bony ridges where bone resorption has already occurred.
• Sinus augmentation: To provide enough extra bone to place dental implants in the upper jaw. Without this procedure, the implants may extend into the air space of the maxillary sinus.

After the procedure

• Healing times: Your dentist will typically allow the grafted bone to integrate fully before placing a dental implant or bridge. This process usually takes three to six months but could take longer. However, in some cases, your dentist can place an implant or bridge at the same time as the bone graft.
• Pain management:
  • Your dentist will typically prescribe pain relievers following a bone graft. The specific medication will depend on your age and health history. Some medications are opioids. Be sure to discuss any specific concerns you may have with the medication prescribed.
  • Like any surgical procedure, bone grafting has post-surgical risks such as swelling, bruising, bleeding, and infection. You can manage most of the symptoms with anti-inflammatory medications and appropriate oral hygiene. Check with your physician or dentist before taking any unprescribed medications for these symptoms.
• Follow-up care: Your dentist will give you specific instructions on how to take care of the surgical area(s). You should request a copy of the instructions. Although the instructions may seem straightforward at the time of your dental appointment, you may need to refer to them later.
  • It is essential to follow the post-treatment home care instructions given by your dentist. This will improve your healing time and help to avoid the risk of infections or other complications.
  • You will also be provided with any suggested dietary modifications and schedule any follow-up appointments.

General risks and concerns

• Smoking greatly increases the risk of bone graft failure.
• Bone grafts may not be possible if you take certain medications to improve bone density or for cancer treatment.
• Bone grafting requires the use of local anesthetic or general sedation. You should be aware of the risks associated with these procedures.
• Bleeding after bone grafting usually is minor. If you are experiencing an abnormal amount of bleeding, gently apply direct pressure to the area and call your dentist immediately. Be sure to follow any specific instructions your dentist gives so you can avoid displacing the graft material.
• You may have trouble chewing in the surgical area(s) for a short period following the procedure. You may also experience a limited ability to open your mouth for a short period of time.
• Some surgical procedures involving bone may have an increased risk of nerve injury. The incidence of nerve injury is relatively low, but you should discuss the possibility with your dentist ahead of time. Nerve injury is almost always temporary.
• If the surgical plan involves using your own bone for all or part of the graft, there is a second surgical site where the bone is harvested. The site is selected based on the preference, training, and experience of the surgeon. This harvesting procedure may produce pain, swelling, infection, bleeding, and bruising.
• Although extremely rare, there are some potential risks to using bone graft material obtained from a tissue bank. Your dentist will discuss these risks with you.

Condition-specific risks and concerns

• If you are taking bisphosphonate medication, you may be required to stop taking it before undergoing a bone graft procedure. Bisphosphonates decrease the blood circulation in head and neck bones more than other places in your skeleton by disproportionately increasing bone density in those locations. This could affect your healing and cause infection following the procedure. This is especially true if you receive the medication through an IV or take steroids or other immunosuppressive drugs. Always consult your physician before changing your dosage or stopping medications.
• Radiation treatment of the head or neck may increase the risk of developing specific complications following bone grafting procedures by reducing circulation in the path of the radiation. Be sure to discuss any past or present treatments involving radiation with your dentist.
• Your dentist and/or physician may require you to temporarily suspend blood-thinning medications before bone grafting. Blood thinners may increase prolonged bleeding at the surgical site.

There are no true treatment alternatives to bone grafts. However, in some situations, certain elements of the bone graft procedure may be achieved using other methods.

• When a bridge is being placed, gum-colored porcelain may be used as an alternative to bone grafting or soft tissue grafting. This can help to prevent replacement teeth from appearing too long.
• If you plan to get a removable partial denture and you have resorbed bone, your dentist can often hide it using a pink denture base material.
• Moving a tooth with orthodontic treatment, while not always an alternative to bone grafting, often helps create some new bone. This newly created bone can be strong enough to support the natural tooth.

Bone resorption will usually occur at the site if you experience tooth loss with no plan to replace the tooth. If enough bone is lost, a dental implant or bridge may no longer be a viable option without more advanced grafting procedures. Replacement teeth will look unnaturally long if placed in a site where resorption has occurred.

• Is there anything in my health history that should concern me about having a bone graft?
• What bone graft materials are the best for me? Can you tell me the pros and cons of each?
• Are there any alternatives to a bone graft?
• Are there any risks associated with using bone graft material from a tissue bank?
• Can this surgery affect the nerves in my mouth?
• What specific things do I need to do to protect the graft site and avoid complications?
• Should I expect any additional treatments? If so, what are they?
• What medication(s) are you prescribing for pain? Do any of them contain opioids?
• What should I do if I think I'm bleeding more than you said I should expect?
• How long will I need to wait before getting dental implants?
• Will bone grafting increase the length of time the implant will need to heal before a tooth can be placed on it?