Bone Grafting Before Dental Implants: How Ridge Preservation, Ridge Augmentation and Sinus Lifts Prepare the Jaw

29 Oct Bone Grafting Before Dental Implants: How Ridge Preservation, Ridge Augmentation and Sinus Lifts Prepare the Jaw

An implant is only as stable as the bone around it. When a tooth has been lost, cracked, or affected by gum disease, the jaw in that spot may be too thin, too short, or too close to the sinus to hold an implant securely. That is where a bone graft for a dental implant comes in. At Gasper Periodontics & Implant Surgery in San Francisco, Dr. Christina Gasper uses three main grafting approaches, and which one you need depends largely on where the tooth is and how long it has been gone.

Why the Jaw Shrinks After a Tooth Is Lost

The bone that holds a tooth is kept in shape partly by the root sitting inside it. Once the root is gone, that bone begins to resorb, losing width first and then height. Periodontal disease, infection around a failing tooth, trauma, and a difficult extraction can all add to the loss. Our article on how dental bone loss happens explains the process in more depth.

Grafting replaces or rebuilds that missing volume so the dental implant can be placed in the right position and fully surrounded by bone. It is a planned step in treatment, not a sign that something has gone wrong.

If the Tooth Is Coming Out Now: Ridge Preservation

When a tooth is being extracted and an implant is planned, graft material can be placed into the empty socket at the time of the extraction. This is called ridge preservation, and its purpose is to limit the shrinkage that would otherwise happen while the site heals. It is usually the most conservative grafting option, and it can reduce the need for more extensive grafting later. In select cases, an implant can even be placed at the time of extraction, although a healing period is often recommended first.

If the Tooth Has Been Missing for a While: Ridge Augmentation

When bone has already been lost and the ridge is too narrow or too short for an implant, ridge augmentation rebuilds it. Graft material is shaped against the existing ridge to restore width, height, or both. Sometimes this can be done at the same appointment as implant placement; in other cases, the graft is placed first and allowed to heal before the implant goes in. Techniques from guided tissue and bone regeneration help protect the graft while new bone forms.

If the Gap Is in the Upper Back Jaw: The Sinus Lift

Above the upper molars and premolars sits the maxillary sinus. After those teeth are lost, the bone between the mouth and the sinus can become too thin to hold an implant. A sinus lift gently raises the sinus membrane and places graft material in the space beneath it.

There are two approaches. When some bone height remains, an internal technique works through the implant site itself, lifting the membrane without a large opening. When bone loss is significant, a lateral-wall technique uses a small window in the side of the sinus so the membrane can be seen and lifted directly. Implants can sometimes be placed at the same time; when they are staged, they are often placed about four to six months later.

What the Graft Itself Is Made Of

Graft material can come from your own bone, from processed donor bone, from animal-derived bone, or from synthetic materials. Each has advantages depending on the size and location of the defect and your medical history. In some cases, Dr. Gasper may add biologic materials, such as enamel matrix proteins or a growth factor, to support healing. She will discuss the material she recommends, and why, before your procedure.

Healing Before the Implant Goes In

Bone grafting at our office is performed under local anesthesia. Mild soreness and swelling are common afterward and are usually managed with pain medication and ice packs, and most patients return to normal daily activities within a day or two. The gum tissue over the graft generally heals in about two weeks, while the bone underneath takes longer to mature. Implants are often placed about three to six months after grafting, depending on how the site heals and how large the graft was.

A sinus lift comes with a few extra precautions. For the first stage of healing, avoid blowing your nose, sneezing forcefully, and heavy lifting. Some swelling, congestion, or sinus pressure for several days is normal, and antibiotics may be prescribed, particularly if you have a history of sinusitis or allergies. Most patients are back to their usual routine within a few days.

Practical Points Before Your Graft

Finding Out Whether You Need a Graft

Whether grafting is needed can only be determined with an examination and X-rays of the site. Dr. Gasper reviews the bone volume, the position of nearby structures such as the sinus, and the health of the surrounding gums, then explains the options during your consultation.

Treating Gum Disease First

Active periodontal disease should be brought under control before grafting, because inflamed tissue heals less predictably. Treatment such as scaling and root planing may come first.

Covering the Cost

Fees depend on the type and size of the graft and whether it is combined with implant placement. Dr. Gasper provides an estimate once she has examined the site, and patients who want to spread out payments can apply for CareCredit financing.

The Periodontist Performing Your Graft

Dr. Christina Gasper is a Diplomate of the American Board of Periodontology and a board-certified periodontist and implant surgeon. She trained in periodontics at UCSF, earned her dental degree at New York University, and has more than 20 years of experience. Learn more on her biography page.

Talk Through Your Grafting Plan With Dr. Gasper

If an implant is in your future and you are not sure whether your bone is ready, an evaluation will answer that question. Contact our San Francisco office or give us a call at (415) 986-4664 to schedule a visit. Healing timelines vary from patient to patient, and Dr. Gasper will map out a schedule based on your own anatomy.