Do I Need a Bone Graft?
Bone grafting sounds like a major operation. Sometimes it is, but most grafting for implants is small and done at the same appointment as the implant. Here is how I decide whether you need one, and what each option involves.
Do I Need a Bone Graft Before a Dental Implant in Edinburgh?
Often not. At Comely Bank Dental in Edinburgh we measure the bone where your tooth used to be on a 3D CT scan, and many people have enough for an implant, or enough once the implant is sized and angled to suit what is there. If some bone needs rebuilding, a small graft is £598 and is usually placed at the same visit as the implant, while a larger graft is £998 and is normally a separate first stage.
Will You Need a Bone Graft for Your Implant?
Not necessarily. An implant needs a sound column of bone around it: enough height to hold its length, and enough width to leave a wall of bone on both the cheek side and the tongue side. If that bone is there, no graft is needed. If it falls a little short in one direction, a small graft placed at the same appointment as the implant usually deals with it. Only when a good deal of bone has been lost does grafting become a separate stage of treatment.
The only reliable way to know is to measure. An ordinary dental X-ray shows height but not width, so for implant planning at Comely Bank Dental I use a 3D cone beam CT scan taken here at our Edinburgh practice. Until I have seen that scan, any answer about grafting, including mine, is a guess.
Why Does Bone Shrink After a Tooth Comes Out?
Once a tooth has gone, the bone that held it starts to remodel. The change is fastest in the first few months after an extraction and affects width more than height, so a broad ridge can become narrow on the cheek side.
How much you lose depends on:
- How the tooth was lost. A long-standing infection, a cracked root or a difficult extraction can damage the thin outer wall of the socket.
- How long ago. A gap that is many years old has usually narrowed more than a recent one.
- Gum disease, which destroys bone around teeth before they are lost.
- The sinus. In the upper back jaw, the air space above the roots can expand downwards once the teeth are gone.
This is why timing matters. If you are about to lose a tooth and might want an implant, talk to us before the extraction rather than after.
Find Out If You Need a Graft
Book a free implant consultation in Comely Bank. If a scan is needed, I'll talk you through what it shows, and you'll receive a written plan with every fee before you decide anything.
What Does the CT Scan Show?
A cone beam CT scan builds a 3D image of your jaw that I can view in slices from any angle. For a possible implant site it shows:
- Height of bone, and how close the nerve in the lower jaw or the floor of the sinus in the upper jaw sits.
- Width of bone at different levels, not just at the top. Some ridges are reasonably wide at the crest but dip inwards lower down.
- The angle of the ridge compared with where the new tooth needs to sit.
- Neighbouring roots, old root fillings and any infection that needs dealing with first.
I then plan the implant digitally on the scan, choosing its length, width and angle and placing it under where the final tooth will be. If bone is missing around that position, the plan shows exactly where and how much, which tells us whether a graft is needed and how large. A CT scan is £160, and I'll show you the images at your consultation.
What Is Socket Preservation?
Socket preservation is a graft placed at the moment a tooth is taken out. After a careful extraction, the empty socket is filled with graft material and covered, usually with a collagen membrane, and the gum heals over it.
Its purpose is to support the walls of the socket while they heal, so less width is lost. It doesn't stop remodelling completely, and not every extraction needs it. I tend to suggest it when:
- you are likely to want an implant later, but it can't be placed on the day of the extraction;
- the outer wall of the socket is thin or damaged, which is common at the front of the upper jaw;
- appearance matters, because a collapsed ridge at the front can make the final tooth look longer than its neighbours.
The implant usually follows three to four months later, once the graft has matured. The fee is set out in your written plan alongside the fee for the extraction.
Small Grafts and Large Grafts: What's the Difference?
Small grafts are placed at the same appointment as the implant. A typical case: the implant sits firmly in the bone, but a few of its threads on the cheek side are exposed or covered by only a very thin layer of bone. I place graft material over that area, cover it with a membrane and close the gum. The implant and graft heal together, so the overall timescale changes little. The guide fee is £598.
Larger grafts rebuild a ridge that has lost too much width or height to hold an implant safely in the right position. More material is needed, it has to be held still while it heals, and the implant usually goes in at a later appointment once new bone has formed. The guide fee is £998.
What the graft is made of. Most grafts use a processed bone mineral, commonly of bovine origin, or a synthetic material, sometimes mixed with a little of your own bone collected during the procedure. It acts as a scaffold that your own bone grows into. Membranes are usually collagen, often porcine. If you would prefer to avoid animal-derived materials, tell me at the consultation so we can discuss alternatives.
What Is a Sinus Lift, in Plain Terms?
Your upper back teeth sit below the maxillary sinus, an air-filled space inside the cheekbone lined by a thin membrane. When those teeth are lost, the ridge shrinks from below and the sinus often expands from above, which can leave only a few millimetres of bone between your mouth and the sinus.
A sinus lift adds bone on the sinus side. The membrane is gently raised, rather like lifting a sheet off a floor, and graft material is placed in the space beneath it. The sinus still works as before; its floor simply sits a little higher.
- Through the implant site. For a moderate shortfall, the sinus floor can be raised a small distance through the same opening used for the implant, often with the implant placed at the same visit.
- Through a small window in the side of the jaw. Where there is very little bone, access is made from the cheek side. This is a bigger procedure and the implant often follows months later.
Afterwards you'll be asked not to blow your nose hard for a couple of weeks. The main risk is a tear in the membrane, which is usually repaired at the time.
Can Guided Planning Avoid the Need for a Graft?
Sometimes, which is one reason I plan every implant digitally.
With the implant planned on your scan, I can test alternatives before any surgery. Would a slightly shorter implant stay clear of the sinus? Would tilting it a few degrees keep it within the bone that is there? Is a narrower implant appropriate for this tooth? The MegaGen AnyRidge implants I use come in a range of lengths and widths, which gives room to fit the plan to your bone.
The plan is then turned into a 3D-printed surgical guide using the MegaGen R2 guided surgery system. The guide fits over your teeth and directs the drilling to the position, angle and depth chosen on the scan. That accuracy is what makes it sensible to use bone that would be too tight to rely on by eye alone.
Planning can't create bone that isn't there, and an implant squeezed into poor bone to avoid a graft is a false economy. When a graft is the right answer, I'll say so.
How Long Does a Bone Graft Take to Heal?
Healing depends on the size and site of the graft and on how you heal, but as a rough guide:
- Small graft with the implant: little or no extra time; the crown usually follows after three to four months.
- Socket preservation: about three to four months before the implant.
- Larger ridge graft: often around six months before the implant, sometimes longer, then further healing before the crown.
- Sinus lift through a side window: commonly six to nine months before the implant.
In the first week, expect some swelling and tenderness, usually at its worst on the second or third day. You may notice a few gritty granules in your mouth; that is surplus material and is normal. Smoking is the biggest threat to a healing graft, and stopping around the time of surgery makes a real difference. Our aftercare page has the day-to-day instructions.
When Is Grafting Not the Right Choice?
Grafting is a well-established part of implant dentistry, but it isn't right for everyone. I would be more cautious, or suggest another route, if you:
- smoke heavily and can't stop;
- have diabetes that isn't well controlled;
- take, or have taken, certain bone-strengthening medicines such as bisphosphonates, or have had radiotherapy to the jaws;
- have active gum disease that needs treating first;
- would simply rather avoid further surgery.
The alternatives include a shorter or angled implant where the scan allows, a dental bridge or a denture. Each has trade-offs, and I'll go through them honestly. If you are nervous about surgery, IV sedation is available at the practice for grafting and implant procedures.
Whatever we decide, every fee is agreed in writing in your treatment plan before treatment starts.
Questions
This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.