Bone Grafting

Periodontal disease is the leading cause of bone loss in the oral cavity, though there are others such as ill-fitting dentures and facial trauma.  The bone grafting procedure is an excellent way to replace lost bone tissue and encourage natural bone growth.  Bone grafting is a versatile and predictable procedure which fulfills a wide variety of functions.

A bone graft may be required to create a stable base for dental implant placement, to halt the progression of gum disease or to make the smile appear more aesthetically pleasing.

There are several types of dental bone grafts.  The following are the most common:

  • Autogenous bone graft – In this type of graft the bone is removed from elsewhere in the body and implanted in the mouth.  Common donor sites for bone grafting include the iliac section of the pelvis, the chin and the posterior third molar areas of the jaw.  If large amounts of bone need to be harvested, the hip or the shin bone (tibia) is generally used.  In our office we will only harvest bone from within the mouth, but most of the time it is unnessesary.

  • Allograft –  Bone can also be obtained from a bone bank. This donor bone is sterilized and processed to remove all live cells and freezed-dried.  The benefit is that we do not need to harvest the bone from the patient at a second surgical site. 

  • Xenograft – This is the implantation of bovine (cow) bone.  A xenograft is perfectly safe and has been used successfully for many years.  Ample bone can be obtained and no secondary donor site is necessary.

Reasons for bone grafting

There are a wide variety of reasons why bone grafting may be the best option for restoring the jaw bone.

Dental implants – Implants are the preferred replacement method for missing teeth because they restore full functionality to the mouth; however, implants need to be firmly anchored to the jawbone to be effective.  If the jawbone lacks the necessary quality or quantity of bone, bone grafting can strengthen and thicken the implant site.

Sinus lift – At upper back tooth locations there may not be enough bone below the sinus floor, so an additional procedure will need to be completed in order to achieve ample bone for implant placement.  A sinus lift entails elevating the sinus membrane and grafting bone onto the sinus floor so that implants can be securely placed.

Ridge augmentation – Depressions in the bone ridge that hold the teeth can occur due to trauma, injury, birth defects or severe periodontal disease.  The bone graft is used to fill in the ridge and make the jawbone a uniform shape.  This will restore the natural contour of the ridge, which will improve the esthetics of the area, and provide enough bone for the placement of a dental implant.

Perodontitis - Gum disease destroys (erodes) the bone around the teeth.  When this happens, the bone has an irregular shape with "pot holes" that can lead to pockets around the teeth.  The pockets make access for oral hygiene difficult and can lead to increased mobility (loosening) of the tooth as the attachment decreases.  Surgical procedures are available which allow access to the bone to remove all the calculus (tartar) from in and around the gums.  Onece this is done, a bone graft can be placed to regenerate the lost bone around the tooth.  After therapy, the inflammation, calculus and pocket will be gone and access for oral hygiene will be improved.   This will allow the patient to maintain the tooth for years to come.

What does bone grafting treatment involve?

Bone Grafting is an effective procedure for treating deformities in the upper and lower jaws.  These deformities can occur as a result of periodontal disease, trauma, injury, wearing dentures, or developmental problems.  Such defects can leave insufficient bone for the placement of dental implants and an additional unattractive indentation in the jaw line adjacent to the missing teeth.

Bone grafting is a procedure which is performed under local anesthetic and IV concious sedation;

At the site to be grafted(augmented), the gum is lifted away from the ridge to fully expose the defect in the bone.   At this time, the grafting material needs to either be harvested or prepared for insertion.  The bone grafting material is then placed at the affected site and secured, which will help regenerate the lost bone.  A membrane is usually placed over the bone graft to protect the graft and stabilize the wound.  Finally, the incision is closed and several months of healing will be required.  A follow up appointment will need to be made within 7-14 days to assess progress.  Depending on the case and type of implant and procedure, a dental implant may be placed during the bone graft procedure or when healing is complete; much depends on the precise condition of the bone.  Bone grafting improves the cosmetic appearance, functionality of the mouth, and the chance of enjoying dental implants for many years.

The bone regeneration process may be aided by:

  • Gum/bone tissue regeneration – A thin barrier (membrane) is placed below the gum line over the grafting material.  This barrier creates enough space for healthy tissue to grow and separates the faster growing gum tissue from the slower growing bone tissue.  This means that bone cells can migrate to the protected area and grow naturally.

  • Tissue stimulating proteins – Enamel matrix proteins occur during natural tooth development.  Emdogain is a matrix protein product which can be placed on the affected site before the gum is sutured.  It mediates the formation of accellular cementum on the tooth, which provides a foundation to allow periodontal attachment to occur.  Tissue stimulating proteins help to create lost support in areas affected by periodontal defects.

  • Platelet-rich growth factors – A high platelet concentration liquid can be used to create a blood clot and stimulate healing at the site of a wound.  It has recently been discovered that PRGF also stimulates bone growth – meaning a denser graft in a shorter time period.

If you would like more information on Bone Grafting in Dallas by Dr. Marshal Goldberg please email, or call 214-890-7777


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