About Bone Grafting
What is Bone Grafting?
Over time, the jaw bone associated with missing teeth atrophies and is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for the placement of dental implants. In these situations, most patients are not candidates for the placement of conventional dental implants.
Bone grafting gives us the opportunity to not only replace bone where it is missing, but we also have the ability to promote new bone growth in that location. This not only gives us the opportunity to place implants of proper length and width, but it also gives us a chance to restore functionality and aesthetic appearance.
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Types of Bone Grafts
Autogenous Bone Grafts
Autogenous bone grafts, also known as autografts, are made from your own bone. Your bone is harvested from somewhere else in the body. The bone is typically harvested from the chin, jaw, lower leg bone, hip, or skull. Autogenous bone grafts are advantageous in that the graft material is your own live bone, meaning it contains living cellular elements that enhance bone growth, also eliminating the risk of your body rejecting the graft material since it comes from you.
However, one downside to the autograft is that it requires a second procedure to harvest bone from elsewhere in the body. Depending on your specific condition, a second procedure may not be warranted.
Allogenic bone, or allograft, is donated bone harvested from a cadaver, then processed using a freeze-drying method to extract the water via a vacuum. Unlike autogenous bone, allogenic bone cannot produce new bone on its own. Rather, it serves as a framework, or scaffold, over which bone from the surrounding bony walls can grow to fill the defect or void. This process is called creeping substitution.
Allogenic bone grafting has an advantage of not requiring a second procedure to harvest your own bone, as with autografts. Small allogenic bone grafts have become as predictable as autografts.
Xenogenic bone is derived from non-living bone of another species, usually a cow (bovine). The bone is processed at very high temperatures to avoid the potential for immune rejection and contamination. Xenogenic grafts supposedly serve as a framework for bone from the surrounding area to grow and fill the void. Xenografts are unpredictable and don’t predictably result in viable human bone and are therefore not recommended by Dr. Kienle, Dr. Steinkeler and Dr. Gunawardena.
Demineralized Bone Matrix (DBM)/Demineralized Freeze-Dried Bone Allograft (DFDBA)
This product is processed allograft bone, containing collagen, proteins, and growth factors that are extracted from the allograft bone. Demineralized bone matrix stimulates your body’s surrounding cells to form more bone. It is available in the form of powder, putty, chips, or as a gel that can be injected through a syringe. This is the most common successful allogenic bone graft material. This is the type of allogenic bone graft that Drs. Kienle, Steinkeler and Gunawardena use most often.
Bone graft composites consist of other bone graft materials and growth factors mixed together to achieve the benefits of a variety of substances. Some combinations may include various mixtures of autologous bone, demineralized bone matrix, collagen membranes, platelet rich plasma gel, and bone morphogenic proteins.
Bone Morphogenetic Proteins
Bone morphogenetic proteins (BMPs) are proteins naturally produced in the body that promote and regulate bone formation and healing. These growth factors are currently synthesized and can be added to the bone grafting procedure to improve bone production. BMP’s are very expensive and are usually reserved for difficult situations or wherever other bone grafting techniques have failed.
Bone Grafting FAQs
How painful is a bone graft?
Most patients having bone grafting do not have extended downtime after their procedures. The grafting is frequently performed at the same time as other procedures and most patients are pleasantly surprised by their recovery.
Does a bone graft last forever?
There are many types of bone grafts. In general, after a bone graft heals and integrates with your own bone, it will atrophy (shrink) if it is not used. This will continue over time and will vary from patient to patient.
How long does a bone graft operation take?
The operation will vary depending on the size and extent of the grafting. The majority of patients needing bone grafting are completed in less than an hour.
How long does it take for a dental bone graft to heal?
Bone grafts take several months to heal and remodel. Bone grafting is fully healed in 4-6 months after the placement.
Can bone graft material fall out?
Yes, most bone grafting material is particulate and not a solid piece. When placed it is packed into the area and often more graft is placed than needed knowing that some of it will be lost over time.