Bone grafting for implants – is it necessary?

Bone grafting for implants may be divided into:

dental implant and bone graft

-minor: where the bone is harvested from inside the mouth and

-major: where the bone is harvested from outside the mouth, for example from the hip.

 

Dental implants act as replacements for your roots allowing crowns, dentures or bridges to be supported on top as natural teeth.

Some patients lack the bone volume in the jaw for implants. The deficiency may be in the height of the bone as well as the width. It is possible to rebuild the height or width of jaw by bone grafting from the hip also known as an iliac crest bone graft.

 

How is it carried out?

Patients needing a major bone graft will have a short stay in hospital. The procedure is done while you are asleep (using a general anaesthetic). You should be given a copy of our leaflet, Having an anaesthetic. If you do not have a copy, please ask.

The procedure is carried out under general anaesthesia so you will be completely asleep and often requires a short stay in hospital:

  • A cut is made in the gum to lift it away in order to assess how much bone will be required. Preoperative scans also help.
  • Blocks of bone and/or marrow are harvested from the hip through a small incision 5-8cm.
  • The wound in the hip is closed with fine bioabsorbable stitches. Mr Andi prefers the running sub-cuticular technique.
  • Often Mr Andi will insert a small tube inside the wound for pain control after the procedure.
  • The harvested bone is transferred to the mouth and secured into position for the wound is closed with bioabsorbable stitches.

Bone grafts usually require a period of healing of up to 3 months before the tissues will be ready for functional loading and or implant placement if this has not been done simultaneously.

 

What are the advantages of a bone grafts and dental implants?

Dental implants can be useful where the alternative treatment may require altering healthy teeth, for example, to provide support for a bridge. Occasionally it may not be possible to provide a bridge due to concerns for the long term stability of health teeth. Bone grafts may be needed to improve the volume and therefore the aesthetics of a proposed implant site. Rebuilding the height and width of an area may be challenging and therefore a compromise may be required.

 

What about the risks?
• Pain, swelling and bruising from the graft site is common. Your hip will be uncomfortable for 3-4 weeks after the operation.
• Swelling of the jaw for 1 to 2 weeks.
• Infection and/or failure of the graft – this is increased if you are a smoker or immunosuppressed.  There is a risk of infection at the donor (iliac crest) site but this is very uncommon.
• Insufficient graft volume/shrinkage after treatment. Further grafting may be required.
• The risk of implant failure is also greater in grafted bone rather than natural bone.

 

What about the alternatives?

There are synthetic alternatives of bone from animals or othe humans but in Mr Andi’s experience these do not perform as well as your own natural bone. Some patients of course reject these on cultural/ religious grounds. An animal/synthetic derived membrane may also be used as a barrier for the graft. These options will be fully discussed with you prior to treatment.

 

What happens post-operatively?

Mr Andi will prescribe painkillers and antibiotics to go home with followed by a review in the clinic one week later.

It is important that yoy do not agitate or brush the grafted area during the first week after insertion. You can use a salty water mouth wash or Corsodyl held in the mouth for one minute before gently spitting out 2 times daily for 1 week.

A soft diet is recommended and if you wear a denture this should be left out until Mr Andi’s review.