Bone grafting, explained.

Jawbone is maintained by the tooth it holds. Once a natural tooth is lost, the bone underneath is no longer protected or stimulated, and it begins to recede and weaken. The longer a gap has been there, the more likely it is that the ridge has narrowed or shortened.

That matters because an implant needs bone on every side of it. Grafting is what makes an implant possible where the bone has already gone — and it is a large part of why implant cases are worth planning with a specialist rather than working around what is left.

Three material types are used, alone or in combination. Which one suits your case depends on how much bone is needed and where.

• Autogenous — bone taken from elsewhere in your own mouth.
• Alloplastic — synthetic bone substitute.
• Xenograft — processed bone of bovine origin.

If any of these raise a question for you — dietary, religious or otherwise — say so at the consultation. There is usually more than one workable option, and it is a reasonable thing to ask about.

We work out where the extra bone will come from and how much is needed. X-rays — usually a 3D scan — let us study the jaw and the sinuses and plan precisely rather than discover the shortfall during surgery.

Tell us about any chronic medication you take. Stop omega 3 and omega 6 supplements two weeks beforehand, as they increase bleeding during surgery.

The most common approach, used where the shortfall is moderate. Granular bone material is packed against the deficient area and held in place while it consolidates.

1. The gum tissue is opened under local anaesthetic.
2. The tissue is raised to expose the deficient bone.
3. Small holes are drilled into the bone surface to encourage a blood supply into the graft.
4. The bone particulate is placed over the planned area, often covered with a membrane and secured with small pins.
5. The incision is closed, and healing begins.

Where there is already enough bone to hold an implant steady, this can be done at the same appointment as the implant placement rather than as a separate stage.

Where a bigger volume of bone is needed, a solid block is taken from elsewhere in the jaw and fixed over the deficient site.

1. The gum is opened over the area to be grafted.
2. A second site is opened in the lower jaw, near the wisdom teeth.
3. A block is cut to fit the recipient area and released with a chisel.
4. The donor site is closed.
5. The block is secured over the deficient area with small bone screws, and any remaining voids are filled with bone scrapings.
6. The incision is closed, and healing begins.

A particulate graft is generally ready for implant placement in about four to twelve months. A block graft is generally ready in about four to six months. The interval gives the new bone time to merge properly with your existing bone, and how long it takes depends on how much bone was needed. We tell you when the site is ready rather than working to a fixed date.

The full post-operative instructions for a bone graft are on the site, and we give you the same sheet before you leave.