A dental bone graft is a surgical procedure that replaces missing bone in the jaw with material from elsewhere in the body. It is an option when the jawbone has atrophied due to injury, disease, or long-term tooth loss. The graft acts as scaffolding that allows new bone to grow, providing stability for implants or dentures. There are several potential sources for the bone used in grafting. The choice depends on the individual patient’s needs and anatomy.
Autograft
An autograft uses bone harvested from the patient’s own body as the graft material. This is often considered the gold standard for bone grafts because it avoids rejection risks. The most common sites for autograft bone include:
Chin
The chin, also known as the mandibular symphysis, is a common autograft source. The surgeon accesses the chin via an incision inside the mouth. A small amount of cortical bone, the dense outer bone layer, is removed from the chin. This area remodels quickly, allowing for repeated grafts if needed. The chin graft provides quality cortical bone but a relatively small quantity.
Hip
The anterior iliac crest of the hip provides cortico-cancellous bone, containing both cortical and spongy interior bone. This site provides larger quantities of bone compared to the chin. However, it requires general anesthesia and leaves an external scar. Hip grafts have a higher rate of postoperative pain and longer recovery times.
Tibia
The tibia shinbone offers another option for cortico-cancellous autografts. As with the hip site, a tibia graft involves an external incision and potential for more postoperative discomfort. The amount of bone available also tends to be less than the iliac crest.
Symphysis
The mandibular symphysis is the midline suture of the two sides of the mandible or jawbone. The symphysis region also contains cortico-cancellous bone that can be used for autografting. This source avoids visible scarring but yields only a limited amount of bone.
Allograft
An allograft uses bone from a cadaver donor as the grafting material. The donor bone is highly processed to remove cells and proteins that could trigger an immune reaction or transmission of disease. Advantages of allografts include avoiding the need for a separate surgical site for bone harvesting. However, allografts carry a low risk of immune rejection or infection.
Xenograft
A xenograft uses bone from a non-human species, usually bovine. The bone undergoes rigorous processing to remove proteins and cells. Xenografts avoid donor site surgery and scarcity issues associated with human allografts. However, they may have higher failure rates compared to autografts or allografts due to increased risk of rejection.
Alloplastic Grafts
Alloplastic grafts use completely synthetic bone substitute materials. Common options include hydroxyapatite, tricalcium phosphate, and calcium sulfate. These grafts act as osteoconductive scaffolds. They lack cells and proteins that generate new bone growth. However, they avoid risks of rejection or disease transmission.
Factors in Choosing a Bone Graft Source
Several factors guide the choice of bone graft source:
Quantity of Bone Needed
Larger defects generally require non-chin autografts or allografts to provide sufficient bone mass. Smaller single tooth defects may only need a chin autograft.
Graft Failure Risks
Patients with health conditions like diabetes or osteoporosis that impair healing may benefit from autografts over allografts or xenografts.
Costs
Autografts only require one surgery, while allografts must be purchased. However, autografts incur costs related to a second surgical site and hospitalization.
Morbidity of Donor Site
The surgeon must weigh whether it’s preferable to operate on a second anatomical site versus relying on allografts or synthetics.
Convenience
Allografts and xenografts can be quickly prepared and do not require recovery from a secondary surgery site.
The Bone Grafting Procedure
Once the graft material is obtained, the surgeon packs it into the bony defect. The graft may be stabilized with fixation screws or membranes. Over several months, the graft incorporates into the native bone through creeping substitution and remodeling. Ideal grafts provide both osteoconductive scaffolding and osteoinductive proteins to stimulate new bone formation.
Post-Operative Care
Proper oral hygiene and antibiotic treatment reduce risks of infection after grafting. Pain medication manages surgical discomfort. Patients should avoid disturbing the graft site during the initial healing. Dental work may be restricted for several months to allow for complete graft integration.
Benefits of Dental Bone Grafts
Bone grafting can restore bone volume lost due to:
- Tooth extraction
- Trauma
- Periodontal disease
- Injury
- Cysts or tumors
This allows for benefits like:
- More support for dentures or bridges
- Correction of bone defects for better appearance
- Stabilization of implants
With proper graft selection and surgical technique, success rates for dental bone grafts are quite high. These grafts can restore form and function, enabling restorative treatments.
Risks and Complications
Bone grafting does carry risks including:
- Infection
- Bleeding
- Nerve injury
- Chronic pain
- Blood clots
- Damage to sinus cavities
- Graft failure or rejection
Proper planning, technique, and postoperative care reduce these risks. With appropriate case selection, the success rates are over 90% for dental bone augmentation using grafts.
Costs and Insurance Coverage
The costs for bone grafting depend on several factors:
- Graft material used – Autografts or non-human xenografts may have lower costs than allografts
- Need for donor site surgery – This adds costs if using autografts
- Amount of grafting needed
- Arch being grafted – Maxilla versus mandible
- Use of fixation membranes or devices
- Hospitalization – Outpatient versus inpatient procedures
Typical fee ranges for the surgeon’s portion alone are:
| Graft Type | Average Cost Range |
|---|---|
| Autograft | $500 – $2,000 |
| Allograft | $250 – $1,000 |
| Xenograft | $250 – $500 |
Many dental insurance plans cover a portion of bone grafting costs, especially when preparatory to implants or prosthetic restoration. Options like financing or savings plans can assist with affordability.
Conclusion
Bone grafts allow restoration of lost jawbone needed for functional and aesthetic restorative treatments. The graft material may come from the patient’s own body, cadaver donors, non-human species, or completely synthetic sources. The maxillofacial surgeon determines the optimal bone source based on defect size, costs, convenience, and other factors. With advanced techniques and materials, bone grafts can successfully restore form and function to the jaw and smile. Though costs and risks are involved, the benefits often make bone augmentation worthwhile before proceeding with implants.