Bone Grafting, Explained

Why the Bone Shrinks

The bone that holds a tooth is kept healthy by the tooth itself: every bite loads the root and the bone responds by staying dense. Once a tooth comes out, that signal stops and the bone slowly remodels away. Much of the change happens in the first year, in width first and then in height, and it carries on more slowly after that. The longer a gap has been there, the more bone may have gone, and a denture pressing on the ridge speeds it up.

That's why an implant placed soon after an extraction is often straightforward, and one placed into a gap that's been there for twenty years sometimes needs the bone rebuilt first.

How We Check

An ordinary X-ray shows bone height but not width, which is why practices working from X-rays alone tend to guess. A CT scan, taken here on our own scanner at your consultation (£160), shows the bone in three dimensions along with the nerve in the lower jaw and the sinus in the upper. It tells us whether an implant can be placed in the bone you have, whether a small graft at the same time would help, or whether the area needs rebuilding first. The implant positions are then planned on the scan and transferred to surgery with a 3D-printed guide.

What Grafting Involves

A bone graft adds material to rebuild the area so the implant has solid bone around its whole length. The graft is usually a bone substitute, a sterile mineral scaffold that your own bone grows into, covered with a protective membrane while it heals. Using a substitute means there's no second surgical site.

• Small grafts fill a thin spot or a gap beside the implant and are placed at the same appointment, under the same local anaesthetic. £535.
• Larger grafts rebuild a ridge that's too narrow or too short to hold an implant safely. They're placed first and left to heal for a few months, then the implant goes in. £998.
• A sinus lift is a graft under the sinus floor for back upper teeth, where the bone is often thin. Whether it's needed, and its fee, is confirmed on your scan and in your written plan.

Expect some swelling and tenderness for a few days after a graft, managed with ordinary painkillers, and a soft diet for a week or so.

The Alternatives to Grafting

Grafting isn't the only answer when bone is thin, and it's not always the best one.

• Shorter or narrower implants can use the bone that's there. Modern implant designs are made to hold well in softer or thinner bone.
• Angled implants reach solid bone in front of the sinus or nerve. Full-arch treatment uses angled back implants for exactly this reason, which is why it rarely needs grafting.
• Placing the implant at the time of extraction, where the socket is sound, keeps most of the bone that would otherwise shrink away.

If you've been told elsewhere that you don't have enough bone, a CT scan here gives you a definite answer, and we'll be honest about which route we'd take and why.

What Affects Success

• Not smoking. Smoking reduces blood supply to the graft and is the biggest avoidable risk.
• Well-controlled diabetes, which heals normally; poorly controlled diabetes doesn't.
• Healthy gums before anything is placed. Gum disease is treated first.
• Following the aftercare: soft foods, gentle cleaning and not disturbing the area.
• Keeping the reviews, so the graft is checked as it heals.

What It Costs

A graft is listed separately in your written plan so you can see exactly what it adds. For full-arch treatment the planning is designed to avoid grafting wherever possible, and where a routine graft is needed on the Staged, Same-Day or Premium pathways, it's already in the pathway fee. Our implant cost guide has every fee.

Questions

This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.