Bone Grafts in Implant Dentistry: When They Are Necessary and What Options Are Available

Tooth loss brings a consequence that many people do not realize at first: the gradual decrease of the bone that supported that tooth. Over time, this bone becomes thinner and lower, making it difficult to place dental implants. When this happens, a fundamental technique of modern dentistry comes into play: the bone graft.

In this article, we will explain in simple terms what a graft is, why it is necessary in some cases, what types are available, and how we choose the most suitable one for each patient.

Why Does Bone Decrease When We Lose Teeth?

The bone in the mouth, both in the upper and lower arches, exists mainly to support the teeth. When a tooth is lost, the bone in that area loses its function and begins a natural process called bone resorption. Within a few months, it is already possible to notice a decrease in bone volume, and over the years, this loss can become significant.

This process occurs both in height and width. Therefore, patients who lost teeth a long time ago often present thin and low bones, which cannot accommodate conventional implants without some prior preparation.

What is a Bone Graft?

A bone graft is a technique in which we add material to the area where bone is lacking, stimulating the body to form new bone in that region. After a few months of healing, the area that was deficient gains sufficient bone volume and quality to safely receive an implant.

It is a very common procedure in modern dentistry, performed thousands of times every day around the world, with excellent results.

When is the Graft Necessary?

Not every patient needs a graft. The necessity depends on a careful evaluation, which includes clinical examination and computed tomography. A graft may be indicated when:

The available bone is too thin to receive the implant. The bone height is insufficient, especially near the sinuses. There has been significant bone loss after old extractions. There is a need to improve the aesthetics around the implant. The patient has bone defects caused by periodontal disease or trauma.

It is important to emphasize: today there are advanced techniques, such as pterygoid, transnasal, and zygomatic implants, which in many cases avoid the need for extensive grafts. Therefore, a specialized evaluation is essential to choose the best path for each case.

Types of Bone Graft

There are different types of material that can be used in the graft. Each has its characteristics, advantages, and specific indications. Let's get to know the main ones.

Autogenous Graft: Bone from the Patient Itself

An autogenous graft is one in which the bone is taken from a region of the patient and transferred to the area that needs reinforcement. Since it is tissue from the patient's own body, it has excellent acceptance and offers very predictable results.

The most common donor areas inside the mouth are:

The chin area, known as the mentum. The area behind the lower wisdom teeth, called the retromolar region. The inner part of the mandible. The tuberosity of the maxilla, behind the last upper teeth.

In more extensive cases, donor areas outside the mouth may be used, such as the cranial vault, the tibia, or the hip, usually in a hospital setting. However, with the advancement of techniques and biomaterials, these more invasive procedures have become increasingly rare.

The advantages of the autogenous graft include a high success rate, rapid integration with the recipient bone, and excellent biological properties, as it carries living cells from the patient. The main disadvantage is the need for a second surgical area to remove the bone, which increases postoperative discomfort.

Synthetic Graft: The Evolution of Biomaterials

Synthetic grafts are materials produced in the laboratory that replace natural bone with excellent results. They are composed of biocompatible substances, such as hydroxyapatite and tricalcium phosphate, which mimic the mineral composition of human bone.

These materials function as a kind of scaffold, on which the body gradually deposits new bone. Over time, the synthetic material is replaced by the patient's real bone in a gradual and safe process.

The advantages of synthetic grafts are significant. They do not require a second surgery to remove bone, which reduces discomfort and recovery time. They are available in unlimited quantities, making them suitable for extensive cases. They have excellent biocompatibility, with a very low risk of rejection. They yield very predictable results when well indicated. And they do not involve ethical or religious issues, as they do not use material from other origins.

Today, synthetic biomaterials have evolved so much that they offer results comparable to autogenous bone in most cases, being the first choice in many clinical situations.

Our Position: We Do Not Use Donor Grafts

It is important to clarify a fundamental point about our clinical practice. There are options in the market for grafts called homografts (bones from human donors, usually from tissue banks) and xenografts (bones of animal origin, usually bovine).

In our clinic, we choose not to use these types of grafts. This choice is based on some important principles. Modern synthetic biomaterials offer very similar results, with predictability and safety proven by science. When combined with appropriate surgical techniques and, in some cases, with grafts from the patient itself, we achieve excellent results without needing to resort to materials from other origins.

Furthermore, by using only synthetic or autogenous grafts, we eliminate any concerns related to the origin of the material, disease transmission (even though extremely rare in regulated materials), or ethical, religious, and cultural issues that some patients may have. We believe that the patient deserves transparency and peace of mind throughout the treatment process.

Maxillary Sinus Lift: A Special Technique

A situation that deserves special attention is bone loss in the posterior region of the upper jaw, near the maxillary sinuses. The maxillary sinuses are natural air-filled cavities located above the upper back teeth.

When we lose the back teeth of the upper jaw, the bone decreases, and at the same time, the maxillary sinus tends to expand downward. Over time, there is very little bone left between the mouth and the sinus, making it impossible to place conventional implants.

The solution for these cases is the maxillary sinus lift, also called sinus graft or sinus lift. The technique involves creating a small access to the maxillary sinus and carefully elevating its internal membrane, creating a space between the original bone and the sinus. This space is then filled with graft material, which over time transforms into new bone, allowing for the installation of implants.

There are two main techniques. The lateral window sinus lift, indicated for cases with little available bone, where access is made from the side of the jaw. And the crestal sinus lift, a less invasive technique, indicated when there is still moderate bone height, where access is made from the very site where the implant will be placed.

The procedure is safe, predictable, and performed millions of times worldwide. Recovery is usually smooth, with some specific guidelines, such as avoiding blowing the nose forcefully in the first few weeks and not making efforts that increase pressure in the head.

In many cases, it is possible to place the implant at the same time as the sinus lift, which reduces the total treatment time. In others, it is preferred to wait for the graft to heal for a few months before installing the implant.

How is the Recovery of Grafts?

Recovery varies according to the type and extent of the graft. In smaller procedures, discomfort is mild, controlled with simple medication, and normal routine is resumed in a few days. In more extensive grafts or sinus lifts, there may be swelling for a few days and some temporary restrictions.

The healing time of the graft before implant placement varies from four to eight months, depending on the type of material used and the extent of the procedure. This time is necessary for the body to transform the grafted material into new bone, capable of securely supporting the implant.

During this period, special care is essential, such as maintaining excellent oral hygiene, following the dentist's guidelines, attending follow-up appointments, and avoiding habits that hinder healing, such as smoking.

How Do We Choose the Best Option?

The choice of graft type and the most suitable technique depends on several factors. The amount of bone needed is the first point: small reconstructions can be done with synthetic material, while more extensive cases may require a combination with the patient's own bone. The area of the mouth also matters, as each area has its own anatomical characteristics. The patient's overall health, age, presence of systemic diseases, and habits such as smoking directly influence the planning. And, of course, the patient's expectations, their availability for treatment, and their individual preferences.

Therefore, each treatment plan is personalized, based on a complete assessment, detailed examinations, and open discussions about all available options.

Conclusion

Bone grafts have transformed implant dentistry, allowing patients with significant bone loss to regain the function and aesthetics of their smiles. With advances in synthetic biomaterials, we now achieve excellent results in the vast majority of cases, with increasingly less invasive and more predictable techniques.

In our clinic, we work with modern synthetic grafts and, when necessary, with the patient's own bone, always aiming to provide the best result with the greatest safety and peace of mind possible. We do not use grafts from human donors or animal sources, as we believe that the alternatives we offer are equally effective and fully respect each patient's preferences.

If you have been evaluated and told that you need a graft, or if you are researching alternatives to rehabilitate your smile, schedule a consultation. A specialized assessment can show all the possibilities available for your case, always seeking the safest, most efficient, and respectful way to restore the smile you deserve.

Modern dentistry offers solutions for practically all cases. The secret lies in seeking updated professionals, with solid training and a commitment to quality and patient well-being.

Prof. Me Robson Ravel de Oliveira

Dentalpos - Maringá

robsonravel@wmundi.com