Bone graft after tooth extraction: Techniques, alternatives, healing, and moreSometimes a tooth is not conservable and must be extracted for various reasons, often because of a dental infection.
After an extraction, bone loss is the most challenging consequence. It occurs because when teeth are missing, the bone is no longer stimulated by the chewing forces. It then collapses, making implant treatment to replace the missing teeth impossible.²
To overcome this problem, your dentist may recommend a bone grafting technique during the procedure.
Find out in this article everything you need to know about bone grafting following a tooth extraction.
What is a bone graft?After examining your mouth, your dentist may suggest a bone graft during the extraction procedure to preserve the volume of your jawbone.
Bone grafting is a surgical technique that involves placing bone or a synthetic biomaterial in the open socket where the tooth was removed.
In short, a dental bone graft is used to prevent bone loss, restore bone volume and strengthen the jawbone so that you can receive an implant later on. There are different types of bone grafts.
Types of dental bone grafts
Autograft: Bone is taken from another part of your body, usually from the back of your mouth, if the amount needed is small or moderate. However, if a large amount is needed, bone can be taken from extra-oral sites such as the skull or iliac crest.
Allograft: Bone is taken from another person, usually a cadaver. Before being used, it is carefully processed to remove any infectious factors or antigens.
Xenograft: The bone used for the graft comes from another species. Like allografts, they also undergo processing before being used in your jaw.
Synthetic material: This is a bone-like biomaterial that can serve the same purpose as other types of bone grafts.
What happens to the jawbone after a tooth extraction?
The alveolar bone begins to shrink progressively, losing 32% of its width at 3 months and 29-63 % at 6-7 months, according to one study. Bone loss then continues at a slower rate in the following year.
As for the teeth bordering the extraction site, they will start shifting to fill the space left. The tooth of the opposite jaw will move vertically. It will then appear longer, loose, and more sensitive.
When you have fewer teeth, you may have to rely on your remaining teeth to do more of the work. This can impact your ability to chew and limit your dietary diversity.
Also, this can lead to increased wear and tear, causing your remaining teeth to become more susceptible to damage and decay over time.
Additionally, losing multiple teeth can impact the appearance of your face. The soft tissues that were once supported by your teeth may begin to sag, leading to a distortion of your facial features. This can make you appear older than you really are, which can harm your self-esteem and confidence.
The role of the socket preservation:Studies have shown that bone grafting directly after tooth extraction can reduce bone resorption by 1.89 mm in width and up to 2.07 mm in height compared to extractions alone.
Thus, bone grafting can prevent and minimize the problem of bone resorption after tooth extraction. This procedure, also called alveolar ridge preservation or socket preservation, aims to maintain the shape and volume of the bone by using different materials.
Autogenous bone grafting (bone from your own body) has always been considered the gold standard for augmentation procedures. It is the only graft that contains living cells, allowing for new bone formation and, therefore, better regeneration.
However, the downside is that it requires a second surgical site. In addition, many studies have found that it is associated with a higher risk of resorption in socket preservation.
For this reason, allografts (bone material from a donor) are the most commonly used for this procedure today. Although it does not allow osteogenesis, allografts still produce good results.
Socket preservation: The procedureHere are the typical steps involved in the socket preservation procedure:
- Examination and Preparation: The dentist will perform a thorough clinical and radiographic examination of the patient's tooth to determine if extraction is necessary.
- Extraction: The tooth is then extracted using local anesthesia. The dentist will try to remove the tooth as gently as possible to avoid damaging the surrounding bone and tissue.
- Socket Cleaning: Once the tooth is removed, the dentist will clean the empty socket of any debris, bacteria, or damaged tissue.
- Bone Graft Placement: The dentist will then place the bone graft material into the socket.
- Membrane Placement: A membrane is placed over the bone graft material to protect it and optimize the healing process.
- Suturing: The surgical site is then closed with sutures. The sutures keep the membrane and bone graft in place and promote optimal healing.
What to expect?After the socket preservation procedure, it's normal to experience some postoperative effects, such as pain, swelling, and bleeding for the first few days.
You can manage these symptoms with over-the-counter painkillers and antibiotics as prescribed by your dentist.
During this period, avoid smoking, drinking through a straw, or eating hard or crunchy foods for several days after the procedure. Instead, opt for soft, warm foods.
Complete healing can take several months. After a few weeks, your gums will begin to return to their normal appearance, but it will take a few months for the bone to fully mature and be ready to receive an implant.
Typically, after four months, your dentist will perform a clinical and x-ray examination to assess the healing process. If your tissues have completely healed and matured, your dentist will give you the green light to proceed to the next step: implant placement.
Immediate dental implant placement: A quick and effective alternativeInstead of waiting for the socket to heal over a long period (4 to 6 months), there is a quick and convenient alternative. We call it immediate implant placement.
It is defined as the placement of an implant into the socket immediately after the extraction.
Immediate implant placement can offer numerous benefits. Firstly, it can reduce the total treatment time, as the dental implant is placed at the same time as the tooth extraction. This means that you won't have to wait for the socket to heal before getting an implant.
In addition, immediate implant placement preserves more of the natural gum tissue and bone and prevents it from collapsing.
However, it's important to know that not all patients are suitable candidates for this option. It depends on factors such as the quality and quantity of the remaining bone and the location of the tooth being extracted. A thorough examination by a qualified dentist is necessary to determine if this technique is appropriate for you.
- A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0501.2011.02375.x
- Effect of Alveolar Ridge Preservation after Tooth Extraction https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293706/
- Alveolar Ridge and Socket Preservation Techniques for Implant Therapy https://decisionsindentistry.com/article/alveolar-ridge-and-socket-preservation-techniques-for-implant-therapy/
- Extraction socket preservation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783174/
- Comparison Study of the Histomorphometric Results after Socket Preservation https://www.mdpi.com/1660-4601/18/14/7451
- The socket-shield technique and immediate implant placement https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128121/
- Which is the best choice after tooth extraction, immediate implant placement or delayed placement with alveolar ridge preservation? https://www.sciencedirect.com/science/article/abs/pii/S1010518219303968