Bone Grafting

Informed Consent Form

When teeth are extracted the alveolar (tooth holding bone) of either jaw will lose 20-25% of its height and width in the first year. Then over the next years, an average of 5-7% will be lost until reaching the dense bone of either the maxilla or the mandible. This loss of resorption can reach dramatic states, i.e. loss of complete jawbone to the point of thin ridges and loss of maxilla to the point of inability to wear dentures.

Bone grafting procedures have been developed by modem oral surgery to enhance alveolar and dense bone via a variety of grafting technologies. The following materials and procedures are but a few of the more common techniques to show you bone growth in order to enhance the placement of implants, preserve teeth or replace missing bone due to disease or accidents, i.e. trauma.

Graft Types

  • Lateral Bone Graft
  • Onlay Bone Graft
  • Veneer Bone Graft
  • Particulate Bone Graft
  • Internal Sinus Lift
  • External Sinus Lift
  • Socket Preservation Grafts

Grafting Procedures

Sinus Lift Grafting Procedure

Informed Consent Form

In many instances, there is lack of bone in your upper jaw to place an implant. The easiest and most convenient way to make bone is to utilize the maxillary sinus which is a hole in the maxillary upper jaw that allows you to breathe and keeps your tissues and health equal.

There are two types of lift procedures. The first is the internal sinus lift in which you have sufficient bone to be raised into the sinus by doing a chisel technique, i.e. different sizes of chisels will raise the sinus floor and then allow enough bone and enough material to be placed into the area so that an implant can be placed. Enclosed you will see the different pictures.

View the slideshow below to see Types of Grafting Procedures:

The second method of bone grafting the maxilla is caused the EXTERNAL SINUS LIFT.
A flap is reflected, the lateral wall or the outside of the wall of the jaw bone is exposed
and a window is made. The membrane is carefully teased upward and the bone is placed
in to the cavity that has been created by the external process. Bone that is replaced in to the cavity can be made out of your own bone, which is autogenous bone, allograft material, ceramic material or freeze dried bone. With the advent of PRP (plasma rich platelet) success has been greatly increased.

View the slideshow below to see an External Sinus Lift:

Subnasal Bone Graft

This is a procedure that is almost identical to the external sinus lift in which the surgeon will need 3 to 4 extra mm of bone in the anterior part of your mouth. An incision is made, the tissue is raised. The piriform aperture of the floor of the nose is exposed, the tissue is raised, bone grafting material can be placed and then the tissues are closed. This process will give the surgeon an addition 3 to 4 mm of bone. Again, autogenous bone, ceramic material, freeze dried bone and allograft material may be placed into the grafting site. If there are any questions about this bone grafting technique, call 617-628-8000.

View the picture presentation of a Subnasal Bone Graft:

Ridge Augmentation Bone Graft

In major cases, bone will be taken from your hip. Prior to any major case consultation will be in order and the surgical procedure will be discussed with you in detail, especially if hospitalization is required and bone from your hip is to be taken. If you have any questions about this, you will call 617-628-8000.

Augmentation bone graft, i.e. if there is lack of bone on your lower jaw or different areas on your upper jaw, there are several intraoral areas the bone can be taken. One will be from the chin, one can be from the posterior jaw bone and these are then transferred to your areas of lack of bone and fixed. Usually a waiting period of six months is necessary.

View the picture presentation of a Ridge Augmentation Bone Graft:


Maxillary Split Technique

Another type of procedure is the splitting of the maxilla upper jaw to place implants. In many cases, a bone graft may not be feasible and the upper jaw is very thin and you have height. The ridge split technique is an excellent technique to allow the placement of implants. The doctor will go ahead and use the chisels and split the maxilla and place the implant. Due to the soft nature of the maxillary bone, it is possible to do this technique. Think of Swiss cheese and think how soft and pliable it is compared to hard wood. Another illustration would be to think of a soft pine tree, the way it bends.

View the picture presentation of a Maxillary Split Technique:

Mandibular Split Technique

In many instances you will have the height for the placement of implants. However, you will not have the width. The doctor will then determine at consultation that it may be possible, instead of doing basic onlay of particulate graft, he may be able to do a two stage split mandibular technique.

(1) A flap is reflected to expose the bone. The bone is then scarred and the flap is then placed back. Three weeks later the flap is opened. The mandible is pushed open and the implants are then placed. This is an excellent technique that will allow for placement of the implants and to avoid complex bone grafting procedures.

For any further information on this technique, do not hesitate to contact 617-628-8000.

Fresh Extraction Socket Graft

The most common graft is the fresh socket graft. In other words, the immediate extraction of a tooth and socket preservation after the extraction.

This is accomplished by placing bone grafting material immediately after the extraction, immediately after the removal of a tooth in a fresh bleeding socket. The key to this technique is a fresh bleeding socket. If infection is present, a surgical procedure will not work.

Chronic infection is not a deterrent to this technique.

The natural healing process will add bone to the area and in the anterior esthetic zone, i.e. from the eye to the eye tooth in the upper jaw, this will preserve the natural architecture and harmony of the bone in this area. After a period of three to six months, the dental implant may be placed.

In some cases, the immediate extraction with the immediate grafting and immediate placement of an implant may be possible. This is a very gratifying technique. When it is accomplished it cuts the time of healing from the six to eight month period down to about five months. These techniques will be discussed with you at your consultation visit, 617-628-8000 for further information.

Immediate extraction, placement of implant plus or minus graft. Another technique for grafting.

This technique is reserved for very few procedures. The incidence of failure is above average.

However, in certain instances is an excellent procedure to allow to save time and energy for the patient.

The technique requires removal of the tooth, if there is facial bone then an implant can be placed modified with a particulate type bone graft. In certain instances, the use of PRP plus the bone grafting will aid in the retention and success rate of the procedure.

It is to be remembered that this technique will allow, if successful, decreased time to where the patient will be able to have integration of the implant. In some instances, immediate extraction, placement of the implant, plus a crown can be placed at the same time. This technique allows the patient to leave the office with a prosthetic tooth and have a smile, but you must remember that the patient cannot chew on the tooth and must have a soft diet for a period of 4 to 6 weeks.


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