What Are Dental Bone Grafts and Do I Need Them?

When are dental bone grafts needed?

If you wish to have dental implants but do not have enough density in your jawbone to support them, then bone grafts could be your solution.

Your dentist can use a CT scan to determine your bone height, shape and density. This is how we will evaluate whether you have experienced enough bone loss to require a grafting procedure.

There are several scenarios that can lead to bone loss, where a bone graft can help. These are the most common reasons for bone loss:

• Gum (periodontal) disease
• Osteoporosis
• Gingivitis
• Cancer
• Traumatic facial injury

Singapore has a high prevalence of periodontal disease. In fact, a recent study from National Dental Research Institute of Singapore (NDRIS) confirms that 31% of residents over 60 years old are without teeth.

Whatever the cause of your bone loss, if there is not enough bone naturally occurring in your jaw to support dental implants, then dental bone grafts may be the solution.

Having well fitting implants is a much more permanent solution than a dental bridge or dentures. If well looked after, your implants may last you a lifetime. This makes having bone grafts to accommodate implants a popular choice for many people.

Socket graft

The most minor procure used is known as a socket graft. This is typically carried out right after the old tooth has been extracted. The graft is added to the extraction site to prevent the further bone loss that patients typically experience after an extraction.

If a tooth is extracted and the site is left to heal without a new implant or bone graft added at the time, then the natural healing process causes some of the surrounding jawbone to reabsorb. This resorption is a natural part of the healing process.

But as the socket graft procedure closes the extraction site and assists the healing process, the surrounding bone tissue is preserved. Healing takes around four months, after which you can proceed to your implant procedure. 

Block bone graft

If you had an extraction, or experienced tooth loss by other means and were left with a gap, then you will have lost some bone in that area. A block bone graft may then be a good option for you.

As the name suggests, a block bone graft involves creating a block of bone to be implanted, shaped to fit the gap in your jawbone. This specially shaped block will be fixed in place with titanium screws. This gives you a solid site for your future dental implants.

Healing from a block bone graft typically takes around 5 months, after which you should be ready for your dental implants.

If the gap in your jawbone that needs to be filled is an irregular shape, then there is another approach that may be more suitable. A mix of bone substitute material, which is softer than a block of bone, can be used to fill the gap.

The grafted material will be covered with a protective membrane to help it heal. This particular procedure also encourages more natural bone growth in the area

Sinus lift

As dental implants have become more popular, so have sinus lifts (also called sinus augmentation). Put simply, they are a technique we can use to help patients with bone loss in their upper jaw.

The sinuses are empty air filled cavities located either side of your nose. The bone in this area tends to be thinner than other parts of your jaw. Some people naturally have sinuses that are just too close together.

Although you might not have heard of this procedure, it’s not uncommon for a sinus lift to be needed with a bone graft to prepare for upper jaw dental implants.

A sinus lift elevates the sinus floor. This creates more space for bone grafts to be inserted, resulting in a strong base for your future implants.

The procedure can be done under a choice of anaesthetic options; local or general anaesthesia, intravenous sedation or nitrous oxide (gas) sedation. Each has pros and cons, which you can discuss with your dentist.

With all procedures, there is an initial recovery period of a few weeks. During this time you will want to eat softer food while your graft settles and any swelling subsides. After the first few weeks, you will be feeling normal, but will still have some months to wait before proceeding to dental implant surgery.

While bone grafting techniques are quite advanced these days, it is worth noting that not all of them are fully successful on the first attempt. Depending on how well you heal, you may need further grafting before a dental implant can be fixed.

The bone graft sources can be:

• Autograft – This is your own bone, often transplanted from the iliac crest of your hip
• Allograft – Bone from a donor, possibly a cadaver
• Xenograft – Bone from an animal donor, often bovine
• Alloplast – A synthetic graft material that contains natural minerals

If you go with the autograft option, this typically has the highest success rate, as it is your own bone. The downside is that you will have a second surgical site where the bone graft has been taken from. You may have some pain after the procedure, but the recovery will be short.

Some people find the idea of an allograft taken from a cadaver a little strange at first. But rest assured this is sourced from a bone bank where it has been extensively sterilized and processed.

Bovine or other animal xenograft materials are also thoroughly processed for safety and turned into a calcified matrix. When grafted in, this provides support to your jaw and helps your own bone to regrow.

Common alloplastic materials are calcium phosphate based ceramics such as hydroxyapatite or tricalcium phosphate. As these are bioactive they remodel naturally and support regrowth of the natural bone too. Being synthetic also eliminates any possibility of disease transmission.

All of these graft material options are widely used in Singapore. Your dentist will be able to advise you on which is most appropriate for your individual needs.

How much do dental bone grafts cost in Singapore?

Referring to the order of graft sources in the list above can give you an insight into the likely costs. At the top of the list, an allograft procedure is the most costly. This is because the procedure involves first removing your own bone graft material from your hip.

Although this is usually the most expensive route, it can pay off in success rate and recovery time. Using bone that is your own usually has the best outcome.

Then at the bottom of the list, the synthetic alloplast grafts are the least costly to obtain.

In Singapore, dental graft costs begin around $800 for the smaller procedures with the alloplast graft material. Higher end procedures with autografting may cost the patient up to $2000. Then at the top end of the scale, surgery involving a sinus lift with bone grafting can cost up to $3500.

This is all exclusive of the final goal of getting dental implants put in. Dental implants are a separate cost.