Yes, in some cases, a bone graft can be done concurrently with tooth extraction. This procedure is called "socket preservation" and is very effective in preventing bone loss.
Bone Graft in İstanbul, Turkey
What is Bone Grafting in Dentistry?
In both the upper and lower jaws, volumetric reductions in bone tissue can occur for various reasons. Factors such as hereditary factors, long-term tooth loss, traumatic tooth extractions, bone loss in areas of missing teeth after gum disease, and cystic and neoplastic formations cause volumetric insufficiency in the bone tissue. This insufficiency not only puts the planned implant treatment at risk but can also lead to aesthetic problems in prosthetic treatments, whether or not an implant is placed. In other words, a bone defect located on the smile line or in a visible location significantly affects an aesthetic smile. For this reason, to increase the insufficient bone volume, we perform a procedure in surgical dentistry that we call "bone grafting."
The bone grafting procedure provides a volumetric increase in the vertical and horizontal dimensions of the area with insufficient bone volume in a 3-dimensional plane. Consequently, the bone volume in the potential implant site allows for the placement of the implant. It should not be forgotten that sufficient bone tissue around the implant not only increases support for the implant but also plays a role in achieving aesthetics. Furthermore, a smooth bone contour ensures tissue harmony between implant-implant, implant-adjacent tooth, and adjacent tooth-adjacent tooth, thereby minimizing food impaction/accumulation in these areas.
Why is a Bone Graft Needed?
- We perform a bone graft procedure when there is not enough jawbone volume in the area where we want to place an implant.
- This procedure is needed for our patients who experience a decrease in jawbone volume due to gum inflammation.
- It is applied to our patients who have experienced bone loss due to trauma, cysts, or tumors.
- Bone resorption in the jawbone can cause facial collapse. For this reason, bone grafting is performed for aesthetic purposes to support the facial contour.
- It is used to strengthen jaw support in prosthesis applications.
What are the Types of Dental Bone Grafts?
Bone graft types are classified according to the source of the graft material. Each type has its own unique advantages and disadvantages:
Xenograft (Animal-Derived Bone Graft)
These are graft particles obtained from bovine bone. These particles can be produced in different sizes according to the purpose of the application. For example, larger particles are used for sinus bone grafting procedures, while smaller-particle bone powders are used in gum disease surgery or procedures aimed at increasing the bone volume of a potential implant site (we call these procedures GBR, or guided bone regeneration).
Xenografts have high biocompatibility and support bone regeneration by acting as a scaffold for new bone formation. Since the risk of infection is extremely low, we frequently prefer them in advanced surgical procedures such as sinus lifting, especially in patients who do not have sufficient bone volume before an implant.
Xenograft (Animal-Derived Bone Graft)
These are graft particles obtained from bovine bone. These particles can be produced in different sizes according to the purpose of the application. For example, larger particles are used for sinus bone grafting procedures, while smaller-particle bone powders are used in gum disease surgery or procedures aimed at increasing the bone volume of a potential implant site (we call these procedures GBR, or guided bone regeneration).
Xenografts have high biocompatibility and support bone regeneration by acting as a scaffold for new bone formation. Since the risk of infection is extremely low, we frequently prefer them in advanced surgical procedures such as sinus lifting, especially in patients who do not have sufficient bone volume before an implant.
Autograft (Graft Taken from the Patient's Own Bone)
This is a bone grafting procedure using the patient's own bones. In this procedure, bone tissue obtained from a different donor site in the patient's own body is transplanted to the volumetrically deficient area. It is usually taken from areas such as the patient's lower jaw (mandible), chin tip, or hip bone. They are considered the most ideal graft type because they contain live bone cells. They are easily accepted by the body and their ossification rates are quite high. However, the fact that this procedure requires a second surgical site can be considered a disadvantage in oral surgery applications. Therefore, in autologous bone graft applications, the donor site in recent surgical procedures is preferred from areas close to the primary surgical site.
Allograft (Human Donor Bone Graft)
Allografts are sterilized and processed bone grafts obtained from human tissue banks (in other words, from a human source/cadaver). With this process, all risks of disease are eliminated. Although they do not contain live cells, they serve as a scaffold for new bone formation. They are moderately accepted by the body. Allografts are particularly preferred in the treatment of small and medium-sized bone defects. There may also be cases where we prefer a mixture of allograft and xenograft materials in GBR procedures and socket preservation procedures after tooth extraction, and thus, results with a higher success rate can be obtained.
Alloplast (Synthetic Bone Graft)
Alloplasts are synthetic materials produced in a laboratory environment. They are bioceramic and phosphate-based synthetic graft materials such as hydroxyapatite and beta-tricalcium phosphate. The risk of infection is minimal, and they do not contain live cells. They only serve as a structural scaffold to support bone formation. They are generally used in small-volume bone fillings and to provide support along with other grafts. For a period, such biomaterials were used not only for grafting purposes but also for coating implant surfaces. Although implant surfaces are not coated with these materials today, they can also be used in the roughening phase of titanium-based implant surfaces to maximize implant-tissue integration.
What are the Advantages of Bone Grafting?
Makes Implant Treatment Possible: The indispensable condition for dental implant applications is sufficient bone volume. Bone grafting procedures applied to a potential implant site with insufficient bone volume increase the bone volume to the required amount for implant placement, thus allowing the implant to be placed. Without sufficient bone volume, implants cannot anchor to the jaw; bone grafts prevent this problem.
Preserves Facial Aesthetics: Irregular decreases and volumetric insufficiency in bone volume in both the upper and lower jaws for various reasons can create aesthetic problems on the smile line. In particular, such bone loss creates an anomaly in the contour layout that provides a harmonious smile. These depressions become more prominent than the aesthetic restoration made and can create aesthetically unsatisfactory results. Therefore, in an ideal smile design, not only prosthetic structures but also soft tissue and bone harmony are addressed. Excessive bone loss can cause depressions in the jaw and facial region lines, creating a separate aesthetic problem. Consequently, bone grafting procedures are an important application that provides smile aesthetics and facial aesthetics.
Provides Functional Gain: With the application of a bone graft, the prosthetic structure alternatives to be applied for the patient increase. Thanks to both ensuring the stabilization of the removable prosthesis during its use and making the choice of an implant possible, the patient begins to perform chewing functions again. Therefore, bone graft applications have a significant share in the patient's regaining of chewing function. With the increase in the volume of the jawbone, there is a significant increase in patients' chewing and balanced biting functions.
Offers Long-Term Stability: It should not be forgotten that as the length and diameter of the implants increase, their rates of meeting and absorbing incoming chewing forces also increase. An ideal crown/implant ratio should be at least one. As this ratio increases, the horizontal forces on the implant will increase even more, and the success of the implant will be at risk. Therefore, increasing the amount of bone vertically and horizontally with bone grafting procedures allows for the choice of a wider diameter and longer implant. This situation provides a longer-term service life and increases the usage period of the implants.
Promotes Natural Bone Regeneration: Biocompatible graft materials trigger, support, and guide new bone formation. These grafts, which promote natural bone regeneration, become more compatible with body tissues. A good graft material not only accelerates the healing process but also reduces the possibility of complications that may occur.
How is a Bone Graft Performed?
Our specialist physicians generally perform the bone graft procedure under local anesthesia with the following steps:
Examination and Planning: Radiographic examination is necessary to understand the need for a bone graft. X-rays are examined by our doctors. The patient's intraoral examination is performed, and their general/systemic medical condition is evaluated in detail. If there is no condition in the general health status that prevents oral surgery, the bone grafting procedure is planned.
Surgical Preparation: A sterile preparation is made for this procedure, which is performed in a sterile environment. To counter the risk of infection, the area where the procedure will be applied is cleaned with an antiseptic solution.
Placement of the Graft: The area where the graft will be applied is reached through a surgical procedure, and the defective area is rehabilitated with the bone graft.
Application of a Membrane: The bone graft is isolated with a barrier (membrane), and the surgical site is closed with sutures.
Healing: New bone formation is generally completed between 4 and 6 months.
How is a Bone Graft Performed?
Our specialist physicians generally perform the bone graft procedure under local anesthesia with the following steps:
Examination and Planning: Radiographic examination is necessary to understand the need for a bone graft. X-rays are examined by our doctors. The patient's intraoral examination is performed, and their general/systemic medical condition is evaluated in detail. If there is no condition in the general health status that prevents oral surgery, the bone grafting procedure is planned.
Surgical Preparation: A sterile preparation is made for this procedure, which is performed in a sterile environment. To counter the risk of infection, the area where the procedure will be applied is cleaned with an antiseptic solution.
Placement of the Graft: The area where the graft will be applied is reached through a surgical procedure, and the defective area is rehabilitated with the bone graft.
Application of a Membrane: The bone graft is isolated with a barrier (membrane), and the surgical site is closed with sutures.
Healing: New bone formation is generally completed between 4 and 6 months.
How Long is the Dental Bone Graft Healing Time?
Although the healing time varies depending on the size of the applied graft, it is generally completed within a period of 4-6 months. The most important factor in the healing process is the nourishment of the graft through vascularization and ensuring the stable healing of the graft by protecting it from external pressures. During this period, bone cells from the adjacent tissue migrate to the graft area and support new bone formation in this region.
Factors such as the patient's age, general health status, smoking, and systemic diseases like diabetes can affect the healing time.
Things to Consider After a Bone Graft
After the bone graft procedure in our clinic, our doctor will inform you in detail and help you get through the healing process smoothly. The general points to consider are as follows:
Oral Hygiene: Oral cleaning should be done without direct contact with the surgical area, and antiseptic mouthwashes recommended by the doctor should be used.
Soft Diet: Soft and cold foods should be preferred for the first 5-7 days.
Smoking and Alcohol: Should not be used for at least 2 weeks as they negatively affect the healing process.
Medication Use: Prescribed antibiotics and painkillers should be taken regularly.
Physical Activity: Strenuous activities should be avoided in the first few days.
Check-ups: You must go for a doctor's check-up until the stitches are removed (usually after 7-10 days).
Since the procedure is performed under local anesthesia, the patient does not feel pain during the operation. After the procedure, there may be slight pain, swelling, or sensitivity, but this is controlled with prescribed medications.
For small grafts, it can take 3-4 months, while for larger grafts, this period can extend to 5-6 months. During this time, new bone formation is observed in the area where the graft is placed.
Can a bone graft be applied to every patient? Generally, yes. However, in special cases such as patients with uncontrolled diabetes, immune system diseases, or those undergoing chemotherapy, a detailed evaluation by the physician is necessary.
A waiting period of 3 to 6 months is generally required for implant application after a bone graft. This period allows the graft to transform into bone tissue and form a solid foundation for the implant.
Yes, most bone grafting procedures are completed in a single session. However, in some advanced cases, staged applications may be necessary.
Slight pain and sensitivity are usually seen for the first 2-3 days. These complaints can be easily controlled with prescribed painkillers.
In some suitable cases, especially with small-volume grafts, it can be done in the same session with the implant. However, this decision depends on the physician's evaluation of the bone quantity and the condition of the area.
