Dental bone graft surgery consists of accessing the bone where the teeth would typically be inserted and implanting a small amount of graft that will allow the height, width, and bone density to be regenerated.
This bone regeneration allows the creation of the appropriate conditions to carry out the dental implant placement procedure successfully.
Below we will explain the step by step of a dental bone graft, when necessary, the possible complications after surgery, postoperative care, and the benefits of a dental bone graft.
When is a dental bone graft indicated?
Dental bone grafting is indicated in cases where the patient has lost a significant amount of bone that affects the health of natural teeth or prevents the implementation of dental implants.
Dental bone grafting is also indicated when a maxillary sinus lift is required, although this is often necessary due to the patient’s own anatomy and not due to dental bone loss.
Why does dental bone loss occur?
Among the main causes of dental bone loss are:
- Severe infectious processes (periodontitis).
- Natural bone loss after losing a tooth.
- Mandibular blows or trauma.
- Prolonged use of removable dentures.
- Cysts in the jaw.
Types of dental bone graft
There are 4 types of dental bone graft:
- Autologous.
- Allograft.
- Xenograft.
- Alloplastic.
Autologous graft
This type of graft is extracted from the patient himself, usually from an area of the mouth where there is healthy bone, although it can be extracted from any part of the body.
The autologous graft is the most efficient when it comes to activating the body’s natural regeneration processes and offers the advantage of being 100% compatible as it comes from the same patient.
Even so, with the advances in synthetic graft materials, the autologous graft is rapidly falling into disuse as it involves performing two surgeries, one in the area where the bone is extracted and the other in the area where it is implanted.
Allograft
An allograft is a dental bone graft that comes from a human donor, is obtained from a tissue bank, and is subjected to various sterilization processes to ensure that it is safe to use.
The allograft represents a much more comfortable option for the patient as it does not require a second surgical field, however, this type of bone graft is more expensive.
Xenograft
The xenograft comes from some animal species, usually bovine or porcine, it also undergoes various sterilization processes to make it completely safe and, like the allograft, does not require extra surgery to extract bone from the same patient.
However, because its regenerative properties are inferior to the two types of bone graft mentioned above, xenograft is used in mild to moderate cases of bone loss.
Alloplastic graft
The alloplastic graft is a synthetic biomaterial developed in laboratories from basic compounds. It currently offers a regenerative potential quite similar to that of the xenograft, additionally, alloplastic graft materials are improving more and more every day.
Step by step of a dental bone graft surgery
- Planning: This first step consists of evaluating the current state of the patient’s mouth, in addition to performing radiographic and tomographic studies that will allow the maxillofacial surgeon to clearly determine the amount and type of graft necessary to restore the area. Certain laboratory tests are also often performed that provide an overview of the patient’s health and greatly reduce the chance of complications during surgery.
- Anesthesia: Dental bone grafting can be performed under local anesthesia as it is an outpatient procedure. However, conscious intravenous sedation and even general anesthesia can be used if deemed necessary. The anesthesia technique is planned prior to the day of surgery.
- Incision: The surgeon makes an incision in the gum to be able to move it and expose the area where the bone graft will be implanted.
- Graft placement: Once access is obtained to the area of the bone defect, the graft material is placed and in many cases, a resorbable membrane is also placed since it favors the healing of the bone graft.
- Suture: Once the graft is in place, the gum is sutured, completely sealing the area.
- Recovery: Recovery after dental bone graft surgery can take about a week, but for the desired bone regeneration to occur, you must wait about six months.
Postoperative care of a dental bone graft
As in any surgery, it is normal for the patient to experience inflammation in the area, pain, and discomfort after the procedure.
However, these symptoms are managed with anti-inflammatory analgesics and antibiotic therapy, making it a short and bearable period for the patient.
The most intense symptoms usually start to diminish rapidly 48 hours after surgery, but it is advisable to maintain the following postoperative care for at least a week:
- Application of cold in the area of surgery.
- Maintain a bland diet.
- Avoid very hot food and drinks.
- Avoid making a physical effort.
- Rinse your mouth with water and salt.
- Sleep in a semi-sitting position, keeping your head elevated.
Dental bone graft complications
Complications of dental bone graft are very rare, since it is a procedure with a high success rate, even so, in special cases the following complications could occur:
- Dental bone graft infection.
- Nerve injury in the area.
- Rejection of dental bone graft.
Fortunately, these complications are very rare and, if they do occur, they respond very well to pharmacological treatment and are therefore easily resolved.
Regarding dental bone graft rejection, this does not really occur because the body rejects the graft since it is a biocompatible material, but because the graft has suffered an infection and this interferes with the healing process, causing the graft fails to regenerate bone.
Making this clear, the only risk of undergoing a dental bone graft is that it fails and, therefore, the desired bone regeneration is not achieved, in which case the procedure must be repeated.
What is a dental bone graft with a membrane?
The resorbable membrane is a mesh that is placed over the dental bone graft to facilitate bone regeneration. This mesh prevents the gum cells from entering the spaces that should be occupied by bone cells.
At the same time, the mesh serves as a support for new bone cells to proliferate in it, similar to how a creeper plant grows in a metal mesh.
The resorbable membrane is not essential in all cases, however, it is often used as it improves the effectiveness of the graft when it comes to regenerating bone tissue.
Dental bone grafting with plasma
Plasma is a substance rich in growth factors and proteins that naturally trigger a regenerative action, accelerating healing processes.
Plasma is obtained from the patient’s blood and its use in combination with dental bone grafts is extremely favorable for bone regeneration.
Does dental bone graft hurt?
The dental bone grafting procedure is performed under anesthesia and therefore the patient will not feel any pain during the surgery.
Once the effects of anesthesia start to wear off, it is normal for the patient to feel mild to moderate pain for the first few days after the procedure, however, postoperative pain can be managed with anti-inflammatory pain relievers.
How to regenerate dental bone naturally?
Unfortunately, it is not possible to regenerate dental bone naturally once it has been lost, the only way to recover bone tissue is through tissue regeneration techniques, such as bone grafts and biocompatible membranes.
