Bone grafting after tooth removal: Why, when, and what to use (2023)

Tooth extraction is a common practice in the United States, with a prevalence of roughly 50% of adults in the age range of 20–64 having at least one tooth extracted. 1 The normal pattern of bone healing following tooth extraction is resorptive, typically leaving both hard- and soft-tissue defects in the alveolus without site preservation and/or tissue grafting.2 This is problematic for various reasons. Loss of tissue structure in the jaw directly affects the functional and esthetic outcomes of dental implants as well as tooth-borne fixed prosthetics (dental bridges).

Why bone grafting?

Although unpredictable, a greater amount of alveolar ridge loss following extraction usually occurs in the horizontal dimension and affects the buccal bone of the ridge.3 In fact, 50% of alveolar bone dimension can be lost after tooth extraction, with losses reported of up to 6–7 mm (figure 1). Two-thirds of this loss of bone volume can occur within the first three months of tooth extraction.4

Loss of vertical ridge height can also occur and usually takes place along the buccal aspect of the ridge to a lesser degree than horizontal ridge loss.5 Corresponding reductions in vertical ridge height ranging from 2–4 mm have been noted.6 The combination of this resorptive pattern results in a ridge that has moved in a palatal/lingual direction and has atrophied vertically (figure 2).

These alveolar bone changes often compromise implant placement due to thin bone volume (figures 3–6).

Reduction in quantity and quality of bone can also compromise functional and esthetic outcomes of both implants and fixed bridge restorations (figures 7 and 8).

When to use bone grafting?

Because of this alveolar resorptive pattern after tooth extraction, bone grafting the extraction socket after tooth extraction procedures has become a solution that attempts to limit the amount of hard- and soft-tissue loss. There are many systematic reviews in the literature that compare the results of residual ridge dimension following tooth extraction after the use of a bone graft (with or without a membrane) versus extraction alone without grafting.7 Sockets that were preserved with bone grafting and/or membrane on average lost 2 mm less of ridge width, 1 mm less of ridge height, and had 20% more bone volume when compared to sockets that were not grafted.8 Maxillary sites lost more than mandibular sites, and most ridge resorption occurred on the buccal aspect of the ridge.

Indications for bone grafting extraction sites include:

site development to increase hard and soft tissue for pontic sites in fixed bridge prosthetics (figures 9–14);

(Video) LIVE SURGERY DENTAL EXTRACTION AND BONE GRAFT

rebuilding defects around adjacent teeth after extracting teeth due to periodontal disease (figures 15–17);

correcting bone defects impinging upon anatomical structures after tooth extraction, such as oroantral communication (figure 18); and

preserving tissue structure for subsequent dental implant therapy.

Decision matrix

With these indications in mind, does every extraction socket need to be grafted? The answer is no. A good decision matrix is based on “A Simplified Socket Classification and Repair Technique” by Elian et al.9

sfds

Classification when existing tooth is still present

Type 1 socket—Buccal plate present and soft tissue present

•Type 1a socket (figure 19)—Thick biotype, posterior tooth, and buccal plate present: no graft needed

•Type 1b socket (figure 20)—Thick biotype, anterior tooth, and buccal plate present: clot stabilizer

(Video) Post-Operative Guide to Tooth Extractions (With or Without Bone Grafting) | Dr. John W. Thousand IV

•Type 1c socket (figure 21)—Thin biotype, anterior or posterior, and buccal plate present: bone graft

Type 2 socket (figures 22 and 23)—Buccal plate missing, but soft tissue present: bone graft +/- membrane (if graft containment is needed)

Type 3 socket (figure 24)—Buccal plate missing and soft tissue missing: bone graft + membrane +/- biologic agent (consider soft-tissue graft if keratinized tissue is less than 2 mm)

What bone grafting product?

Although there are many types of grafting products commercially available, choosing the right one may be difficult. An ideal bone graft substitute should be biomechanically stable; able to degrade within an appropriate time frame; exhibit osteoconductive, osteogenic, and osteoinductive properties; and provide a favorable environment for invading blood vessels and bone-forming cells.10 The graft material used should facilitate the three tenets of bone regeneration: clot stability, space maintenance, and blood supply/bone-forming cells.11 Unfortunately, many clinicians assume all grafting products are created equal and select the material based on price point alone. If the bone grafting material is not formulated correctly, degradation may not occur, and the graft can become fibrously encapsulated, leading to poor bone turnover and graft failure (figures 25–27).

One particularly good bone graft material that provides scaffolding space maintenance as well as stabilizes the blood clot is Geistlich Bio-Oss Collagen (Geistlich Pharmaceuticals).12 Geistlich Bio-Oss
Collagen is 90% Bio-Oss granules (size range 0.25–1.0 mm) and 10% collagen. The proprietary formulation of the collagen component gives the material its scaffolding and moldability qualities, which makes it an excellent product for site preservation after tooth extraction, especially during flapless site preservation.13 Finally, this graft material has been shown to outperform other graft materials in comparative studies looking at site preservation after tooth extraction.14

Editor’s note: This article originally appeared in Dental Economics’ partner publication Perio-Implant Advisory, a chairside resource for dentists and dental hygienists for issues relating to periodontal and implant medicine. Visit perioimplantadvisory.com to sign up for a newsletter subscription.

Read more about bone grafts in “A review of bone graft material” by Adam Bear, DDS, on the PIA website.

Originally posted in 2019 and updated regularly

(Video) What is a dental bone graft?

References

1.Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and tooth loss in adults in the United States, 2011–2012. NCHS data brief, No. 197. Hyattsville, MD: National Center for Health Statistics; 2015. https://www.cdc.gov/nchs/data/databriefs/db197.pdf.

2.Agarwal G, Thomas R, Mehta D. Postextraction maintenance of the alveolar ridge: rationale and review. Compend Cont Educ Dent. 2012;33(5):320-324; quiz 327, 336.

3.Hansson S, Halldin S. Alveolar ridge resorption after tooth extraction: A consequence of a fundamental principle of bone physiology. J Dent Biomech. 2012;3:1758736012456543. doi:10.1177/1758736012456543.

4.Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23(4):313-323.

5.Lekovic V, Camargo PM, Klokkevold PR, et al. Preservation of alveolar bone in extraction sockets using bioabsorbable membranes. J Periodontol. 1998;69(9):1044-1049. doi: 10.1902/jop.1998.69.9.1044.

6.Lam RV. Contour changes of the alveolar processes following extraction. J Prosthet Dent. 1960;10:25-32.

7.Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV. Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res. 2014;93(10):950-958. doi:10.1177/0022034514541127.

8.Aimetti M, Manavella V, Corano L, Ercoli E, Bignardi C, Romano F. Three‐dimensional analysis of bone remodeling following ridge augmentation of compromised extraction sockets in periodontitis patients: a randomized controlled study. Clin Oral Implants Res. 2018;29(2):202-214. doi:10.1111/clr.13099. Epub November 17, 2017.

(Video) Bone Graft Procedure: What to expect?

9.Elian N, Cho SC, Froum S, Smith RB, Tarnow DP. A simplified socket classification and repair technique. Pract Proced Aesthet Dent. 2007;(19)2:99-104; quiz 106.

10.Janicki P, Schmidmaier G. What should be the characteristics of the ideal bone graft substitute? Combining scaffolds with growth factors and/or stem cells. Injury. 2011;42(suppl 2):S77-S81.

11.Mellonig JT, Triplett RG. Guided tissue regeneration and endosseous dental implants. Int J Periodontics Restorative Dent. 1993;13(2):108-119.

12.Araújo Mauricio, Linder E, Wennström J, Lindhe J. The influence of Bio-Oss Collagen on healing of an extraction socket: an experimental study in the dog. Int J Periodontics Restorative Dent. 2008;28(2):123-135.

13.Cardaropoli D, Tamagnone L, Roffredo A, De Maria A, Gaveglio L. Alveolar ridge preservation using tridimensional collagen matrix and deproteinized bovine bone mineral in the esthetic area: a CBCT and histologic human pilot study. Int J Periodontics Restorative Dent. 2018;38(suppl):S29-S35. doi:10.11607/prd.3702.

14.Scheyer ET, Heard R, Janakievski J, et al. A randomized, controlled, multicentre clinical trial of post‐extraction alveolar ridge preservation. J Clin Periodontol. 2016;43(12):1188-1199. doi:10.1111/jcpe.12623.

SCOTT FROUM, DDS, a graduate of the State University of New York, Stony Brook School of Dental Medicine, is a periodontist in private practice at 1110 2nd Avenue, Suite 305, New York City, New York. He is the editorial director of Perio-Implant Advisory and serves on the editorial advisory board of Dental Economics. Contact him through his website at drscottfroum.com or (212) 751-8530.

FAQs

Why would I need a bone graft after tooth extraction? ›

A bone graft is usually necessary after a tooth extraction since the bone can start to melt away. This can cause your facial features to sag, so a bone graft can help provide needed structure and support.

When do you get a bone graft after tooth extraction? ›

Sometimes called ridge preservation, this type of graft is placed in the socket immediately after a tooth extraction. It fills the void left behind by the missing tooth and prevents the sides of the socket from caving in. Ridge augmentation.

What happens if I don't get a bone graft after tooth extraction? ›

What can happen if you don't get a bone graft after an extraction? The bone will heal, but it will heal in its own way – meaning that the walls that used to house that tooth could collapse in and cause you to lose height of bone and you may also lose width of bone.

Do I need antibiotics after tooth extraction and bone graft? ›

After your bone grafting surgery, your dentist will prescribe antibiotics to prevent infection. Make sure to take and finish the antibiotics completely as directed. Bone grafting surgeries are mostly pain-free however, in some cases, pain medication can be given as well if you experience pain.

Why does my dentist want to do a bone graft? ›

If you have severe gum disease known as periodontitis, you may have lost some of the bone that holds your teeth in place. Your dentist or a gum disease specialist (periodontist) may suggest a bone graft. Bone grafts can help grow new bone to replace the bone destroyed by periodontitis.

Do all tooth extractions require a bone graft? ›

A bone graft is not always necessary after a tooth extraction, but there are some cases in which it may be. These cases include: To stabilize the jaw bone. To prevent further bone loss.

What helps bone grafts heal faster? ›

How to Make Bone Grafts Heal Faster?
  • Protect the graft from infection. Infection is one of the main reasons for graft failure. ...
  • Take care of your overall oral health. ...
  • Reduce Swelling by Using Ice Packs. ...
  • Don't Smoke. ...
  • Eat Healthy Nutritious Foods. ...
  • Rinse with Saltwater.
9 Aug 2022

When can I eat solid food after bone graft? ›

For the first 2 days, your diet should be softer, and avoid hot liquids or chewing on the implant or bone graft site. After 48 hours, it is usually safe to resume your normal diet but try to avoid chewing on the surgical site for as long as possible.

Can you brush your teeth after bone graft? ›

After 3–4 days, you may begin brushing the site gently. After 2 weeks, you should resume normal brushing of the site to keep it as clean as possible. You may stop using the prescribed mouth rinse (Peridex) after 1 week.

Is dental bone grafting worth it? ›

Bone grafting can successfully rebuild bone in areas where it is deficient, ensuring there is enough healthy bone for dental implant treatment. Another reason for having bone grafting is to help improve the overall aesthetics of treatment.

Can you dislodge a bone graft? ›

Vigorous rinsing can dislodge the bone graft, causing failure of the bone graft. You may use over-the-counter alcohol-free mouthrinse or water.

Can your body reject a bone graft in the mouth? ›

Can my body reject the graft? No, because it does not contain any genetically coded or living material — only minerals. The sole issue is how much bone your body will make in response to the graft.

How long will my face be swollen after bone graft? ›

The swelling is greatest 2-3 days after surgery, and may remain for an additional 3 days before it starts to resolve. Immediately after surgery, place ice packs over the area.

When can I use mouthwash after bone graft? ›

Oral hygiene is very important following a bone grafting surgery. Do not rinse your mouth or brush your teeth in the area of your surgery until the day after surgery. The next day you may rinse your mouth with the prescription mouthwash, Peridex, twice a day, in the morning and the evening before bedtime.

Can bone graft cause problems? ›

Bone grafting is generally safe, but it does have some rare risks. There is also a risk that your bone might not heal well even with your bone graft.

What is the success rate of bone grafts? ›

Composite bone grafts have 99.6% survival rate and 66.06% success rate. Allografts have 90.9% survival rate and 82.8% success rate.

How painful is dental bone grafting? ›

There is little to no pain associated with a bone graft because the dentist will sedate the patient throughout the entire process. Even when the graft is healing, there should not be any pain. Once the graft has healed, the patient will be ready for their implants.

Who is a candidate for dental bone graft? ›

Bone loss. Those whose appearance has been damaged by bone loss may potentially benefit from dental bone grafts. Loss of bone mass in the jaw can make the face appear shorter than it was.

Can a regular dentist do a bone graft? ›

There are several ways dental bone grafting can be done, but the basic procedure is the same: A dentist or oral surgeon makes an incision in the jaw and grafts (attaches) other bone material to the jaw. A dental bone graft is usually done if someone has lost one or more adult teeth or has gum disease.

What foods are good for bone grafting? ›

Eat a lot of high-calcium foods to help the bone graft become strong and sturdy. Eating more cheese, yogurt, and even ice cream can help boost your calcium, just as spinach and other greens can also do. Make sure to each a lot of produce of differing colors, as that is the best way to boost your nutritional intake.

When should bone graft stop hurting? ›

Pain may last for 10–14 days following surgery. Usually the third day is the most uncomfortable. Following surgery, you should eat a soft diet for 24–48 hours. Avoid chewing over the surgical sites until instructed otherwise by your doctor.

How do you care for a bone graft after tooth extraction? ›

Do not touch or disturb the wound. Minimize spitting or rinsing for the first 24 hours, to allow the blood clot and graft material to stabilize. Do not push your tongue or fingers on the grafted area. The material is movable during the first few days of healing.

When can I use toothpaste after bone graft? ›

Do not brush the adjacent teeth on either side of the graft site for the first 7 days. After 7 days, you may gently brush the tooth surfaces of the adjacent teeth, as long as the bristles do not disturb the graft site.

What can I eat 4 days after bone graft? ›

Start with soft to liquid foods such as yogurt, pudding, applesauce, mashed potatoes, soup, smoothies, and protein shakes. Once the numbness has dissipated, solid foods can be reintroduced to your diet.

When can I use electric toothbrush after bone graft? ›

Avoid vigorous brushing of the surgical area for 1 week while the tissue is healing and sutures are present. NO ELECTRIC TOOTHBRUSHES OVER THE SURGICAL SITE for the duration of its healing.

How do you sleep after dental bone graft? ›

Sleeping and Activity Restrictions for Bone Graft Patients

Bone graft patients are typically advised to sleep on their backs, propped up with pillows, to prevent blood from pooling at the surgery site. Elevating the head keeps inflammation to a minimum, which expedites the recovery period.

How long does it take for dental bone graft to harden? ›

The graft "matures," or turns into your own bone, over a period of 3-6 months. An implant appointment will be scheduled once your graft has matured.

How long do stitches stay in after gum graft surgery? ›

DO NOT manipulate any stitches at the GUM GRAFT SITE. These stitches are resorbable and will dissolve in 4 to 7 days. The HARVEST SITE will have either a liquid band-aid or resorbable stitches. The liquid band-aid will chip away over the next 1-2 weeks.

Will gums grow over bone graft? ›

Will gums grow over bone graft? Your gum will grown over bone graft material withing two weeks. In the meantime, a membrane and small sutures may be placed to cover the bone grafting material.

What is the white stuff after bone graft? ›

A membrane may have been placed over the grafting site to aid in healing. It may appear as a white object in the socket site. Generally, after the first couple days a part of it will loosen and come out. This is normal.

Does a bone graft Change your face? ›

Restores facial structure – bone grafting can correct changes to your facial structure that occurred due to bone loss. Your oral surgeon's capabilities likely won't end with bone grafting. If your case is severe or uncommon, there are still options available to improve your candidacy for dental implants.

What does a bone graft look like in your mouth? ›

What is a dental bone graft? - YouTube

How do I know if my dental bone graft is infected? ›

The signs of an infection usually appear shortly after the bone graft procedure. They include swelling and redness, discomfort, pain and bleeding. While some of the symptoms are normal after the procedure, if they persist it is important to call our office.

Can I drink milk after dental bone graft? ›

Avoid all dairy and milk products for 72 hours after surgery. 2. Please use an antibacterial rinse as prescribed. (Please note the mouth rinse may stain your teeth but the stain is completely reversible).

Can I drink coffee after bone graft? ›

NOTHING HOT TODAY or for 2 weeks following surgery!

You may drink cold and room temperature items. Cold coffee, tea etc. is OK! You may begin with soft foods (smoothies eaten with a spoon, mashed potatoes, soft pasta, soups, eggs, tender fish etc.).

What is the next step after bone graft? ›

Again, bone grafts usually need 4 months of healing prior to implant placement. IMPLANT SURGERY APPOINTMENT: The implant fixture is surgically placed in the bone at this stage. If necessary, bone graft and membrane will be added to augment any areas of deficient bone and to maximize the success of the implant.

› instructions › after-... ›

The gauze pad placed over the surgical area should be kept in place for a half hour. Refer to the section on bleeding for more information. Vigorous mouth rinsi...
While having a bone graft can be helpful, it can also cause harm if you don't follow the aftercare instructions following your procedure.
Procedures like dental implants are common. To provide optimum results, dentists often recommend bone grafting to provide favorable outcomes for the implants. A...

Can you get dry socket if you have a bone graft? ›

Dry socket can also happen with a bone graft. However, it's less likely than with a regular extraction because the wound is well-covered after the graft to ensure the bone has time to integrate into your jaw.

How painful is a dental bone graft? ›

Because bone grafting is performed while the patient is under anesthesia, there is virtually no pain during the procedure. After completion, there may be swelling, bruising, bleeding, and mild discomfort once the anesthesia wears off.

Is a bone graft serious? ›

Bone grafting is generally safe, but it does have some rare risks. There is also a risk that your bone might not heal well even with your bone graft. Many of your specific risks will vary according to the exact reason for your bone graft.

Is bone graft done on same day as tooth extraction? ›

Often times a bone graft is performed at the same time as your tooth extraction. If this is the case, the grafting material is placed into the socket directly after the tooth removal. By performing a bone graft at the same time as your extraction it saves you from multiple surgeries and appointments.

How can I make my dental bone graft heal faster? ›

How to Make Bone Grafts Heal Faster?
  1. Protect the graft from infection. Infection is one of the main reasons for graft failure. ...
  2. Take care of your overall oral health. ...
  3. Reduce Swelling by Using Ice Packs. ...
  4. Don't Smoke. ...
  5. Eat Healthy Nutritious Foods. ...
  6. Rinse with Saltwater.
9 Aug 2022

How do I know if my dental bone graft is healing? ›

In general, you can expect to feel more normal after a few weeks. After your initial recovery, your bone graft will need time to heal and grow new jawbone. You shouldn't feel any pain during this growth process, but know that it may take several months.

How long do I keep gauze in after bone graft? ›

The gauze pads placed over the surgical areas should be kept in place for 30-60 minutes. After this time, the gauze pads should be removed and discarded.

How long does your mouth hurt after bone graft? ›

Pain After Dental Bone Grafting

A patient can expect to experience a level of pain and discomfort after dental bone grafting procedures. Pain following the surgery should subside after three to four days.

What can I eat after bone graft surgery? ›

Start with soft to liquid foods such as yogurt, pudding, applesauce, mashed potatoes, soup, smoothies, and protein shakes. Once the numbness has dissipated, solid foods can be reintroduced to your diet. You may be on a softer diet for a day or two. Advance to a normal diet as tolerated.

How do you sleep after tooth extraction and bone graft? ›

For the first 2 nights after the procedure, sleep in a recliner chair or with your head propped up in bed. However, a recliner is better because it ensures that your head stays upright.

What is the next step after bone graft? ›

Again, bone grafts usually need 4 months of healing prior to implant placement. IMPLANT SURGERY APPOINTMENT: The implant fixture is surgically placed in the bone at this stage. If necessary, bone graft and membrane will be added to augment any areas of deficient bone and to maximize the success of the implant.

What are the risks of a dental bone graft? ›

Pain, swelling, and/or inflammation around the donor and grafting site. Bleeding or infection. Injuries affecting your nerves. Your body may reject the bone graft.

Will gums grow over bone graft? ›

Will gums grow over bone graft? Your gum will grown over bone graft material withing two weeks. In the meantime, a membrane and small sutures may be placed to cover the bone grafting material.

Can you brush your teeth after bone graft? ›

After 3–4 days, you may begin brushing the site gently. After 2 weeks, you should resume normal brushing of the site to keep it as clean as possible. You may stop using the prescribed mouth rinse (Peridex) after 1 week.

How long does it take for gums to heal after bone grafting? ›

In the bone graft healing stages, the incision in your gums will heal quickly – usually within a couple of weeks or sooner. Tooth extraction bone graft healing will take more time. The area where the grafting material is applied takes more time to get back to normal – sometimes as long as nine months.

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3. Dental Implants & Bone Grafting after Tooth Extractions
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4. Post-Op Instructions: Bone Grafting at Naperville Oral Surgery & Dental Implants
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