Your dentist says there is not enough bone for an implant, and suddenly there is an extra procedure, an extra wait and an unfamiliar word. A dental bone graft puts bone back into the jaw so the site is ready for an implant. Here is what dental bone graft surgery involves, what the materials are, and how long bone grafting really takes.
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What a Dental Bone Graft Is
In plain terms, a graft grows bone where there is not enough of it.
The American Academy of Periodontology describes the version done to rebuild a ridge, which it calls ridge modification: the gum is lifted away from the ridge to expose the void where bone is missing, and that void is filled with bone or a bone substitute to build the ridge back up. A graft may be placed under a membrane that dissolves under the gum, to protect it while it heals.
The FDA regulates these materials, where they carry no therapeutic drug, as Class II devices intended to fill, augment or reconstruct bony defects of the mouth and jaws.
Why the Jaw Loses Bone
The AAP names the causes of a deficient ridge: periodontal disease, wearing dentures, developmental defects, injury or trauma. Missing teeth belong on that list too: when teeth are gone for a while, the jawbone atrophies, or resorbs.
A systematic review of 20 studies measured what happens after an extraction: horizontal bone loss of 29 to 63% and vertical loss of 11 to 22% at six months. Most of it happens early, with rapid loss in the first three to six months and slower change after that.
Gum disease takes bone a different way. In advanced gum disease the bone supporting the teeth is destroyed, and the AAP describes regenerative procedures as what a periodontist may recommend once that has happened.
Been told you need a graft before an implant? Call our Everett dental office and we will talk it through.
What a Graft Is For
Making an implant possible. Deformities in the jaw can leave too little bone to place an implant, and grafting repairs sites where previous extractions, gum disease or injuries have left the bone short. If you are considering a dental implant, this is usually why a graft comes up.
Rebuilding the shape of the ridge. The AAP says ridge modification has been shown to improve the jaw’s appearance and to increase the chances of successful implants.
Preserving the socket at the extraction. A graft placed at the time a tooth comes out limits the loss rather than repairing it later. In a meta-analysis of randomized trials, grafting a socket saved about 1.89 mm of ridge width and 2.07 mm of height on the cheek side of the socket compared with extraction alone. The same paper is clear that some bone loss should still be expected. It is a judgment made at the extraction, not a rule.
The Materials, in Plain Words
Dentistry uses four groups, and the names describe where the material comes from:
- Your own bone (autograft), taken from another site, is the only type that carries living bone-forming cells.
- Donated human bone (allograft), processed for safety, acts as a scaffold.
- Animal-derived material (xenograft), usually bovine or porcine, also acts as a scaffold.
- Synthetic material (alloplast) does the same job with manufactured material.
Your own bone is the only one that both carries bone-forming cells and prompts the body to make more, which is why reviews call it the gold standard. The catch is a second surgical site, a limited supply, and resorption that varies.
Sinus Lifts, for the Upper Back Jaw
The upper back jaw is one of the hardest places to put an implant, the AAP says, because the bone there is often thin and the sinus sits close above it. A sinus augmentation, or sinus lift, corrects that by raising the sinus floor and developing bone for the implant.
The AAP describes it plainly: an incision exposes the bone, a small circle is cut, that piece is lifted into the sinus like a trap door, and the space underneath is filled with graft material.
What Bone Grafting Involves, and How Long It Takes
For a ridge graft, the steps are the ones above: the gum is lifted, the void is filled, and a membrane may be placed over it. For gum disease, a regenerative graft starts with folding back the gum and removing the bacteria, then placing the graft or membrane.
The wait is the part worth planning around. The bone is usually left to develop for four to 12 months before implants can be placed, though in some cases the implant goes in at the same time as the graft. After the implant is placed there is a second wait, because the bone has to grow around it, which the ADA says can take up to several months before the replacement tooth is attached.
On comfort, the honest version is the AAP’s: many patients experience minimal discomfort during the procedure. That is during, and it is many rather than all. Nitrous oxide and oral sedation are available here if the appointment itself is the worry.
You’ll be given written aftercare instructions for your own case. Follow those, and call the office during opening hours if something does not seem right. If something is seriously wrong when the office is closed, seek urgent medical care.
What Can Go Wrong
It is surgery, and the honest figures are worth seeing.
- In a meta-analysis of ridge augmentation with membranes, the complication rate was 8.4%, most often the membrane becoming exposed.
- With sinus lifts, the membrane can be perforated. A 2024 meta-analysis found perforation reported in 7% to 56% of cases, averaging about 29%. In the same review, survival was 97.1% across 1,044 implants where a perforation was repaired and 97.7% across 2,725 where the membrane was intact, a difference that was not statistically significant.
- The FDA’s own list of what can go wrong with a graft material is short: bone that does not form as intended, a reaction in the tissue, infection, and improper use.
Be wary of any single “bone graft success rate”: what exists is how much bone is gained, how often complications happen, and how implants do afterwards, three different numbers.
Everett, WA
Not sure whether you need a graft?
An exam is how we find out how much bone is there and what the site needs.
What Affects Healing
- Smoking. Tobacco use can slow healing, and it is the most significant risk factor for gum disease. In sinus grafts specifically, smokers showed greater chances of complications. A meta-analysis of over 150,000 implants found a 140.2% higher failure risk in smokers.
- Diabetes and general health. Conditions such as diabetes may interfere with healing after surgery. A meta-analysis of implants in people whose diabetes was under control still found a higher failure risk than in people without it.
- Medicines for osteoporosis or cancer that affect bone. These carry a risk of a jaw problem called osteonecrosis, and how big it is depends on which medicine: roughly 0.001% to 0.01% of people taking the oral versions for osteoporosis, and 1% to 10% of people on the intravenous versions for cancer that has spread to bone. It is linked to procedures that involve the bone, but it can also happen without any dental treatment. An ADA expert panel has said this kind of medicine does not appear to rule out an implant, while noting that larger and longer-term studies are needed, so tell us what you take rather than assuming you are ruled out.
Who Does This at Icon Dental Center
Bone grafting and sinus lifts here are done by Dr. Betsy Mosquera, our periodontist. The AAP notes that periodontists train for three years beyond dental school and are trained in the comfort measures used during treatment.
What a graft costs depends on the site, what is being rebuilt and whether it is done alongside an extraction or an implant, and insurance plans differ widely in what they cover. We are in network with Delta Dental/WDS, Regence, Premera, Aetna and Cigna, and out of network with MetLife, United and Concordia. Call the office and we’ll go through yours before you decide anything.
Common Questions About Dental Bone Grafts
How long after a bone graft can I get an implant?
Usually four to 12 months, while the bone develops, and there is a second wait after the implant goes in.
Will I be put to sleep for a bone graft?
Not here. Icon Dental Center offers nitrous oxide and oral sedation only. Dentistry elsewhere also uses injected sedation and, on occasion, general anesthesia. The AAP says periodontists are trained in the comfort measures used during treatment.
Can I have an implant without a graft?
Sometimes. A graft is what fixes a site where there is too little bone to hold an implant; where there is enough bone already, no graft is needed. When a graft is needed, the implant sometimes still goes in at the same visit.
Where does the bone come from?
From four places: you, a human donor, an animal source or a synthetic material. Which one suits a case is part of the plan you are given.