The Different Healing Stages of a Dental Bone Graft

Bone grafting procedure steps
Dental bone grafting is a frequent and highly successful procedure that opens doors for other restorative treatments. If you've recently received a bone graft, you might be curious about the healing journey ahead. How long does it take for the graft to integrate with your jawbone? What stages will you encounter, and what can you expect in the future?

In this article, we'll explain all you need to know about dental bone graft healing. We'll discuss the stages, aftercare, and potential complications.

What is a Dental Bone Graft?

Dental bone grafting is a procedure where we add bone or synthetic material to your jawbone. The most frequent reason is the need for additional bone to enhance strength and stability for implant placement. Other times, it's to support a tooth that's lost some supporting bone due to gum disease. The aim here is to help it hold in place over the long term.

Now, there are different types of bone grafts:


Autogenous Graft: We take bone from your own body, which contains living cells capable of making new bone. The great thing is there's no risk of rejection because your body recognizes it. The downside? It means a second surgical site (the donor site).


Allogenic Graft: This bone comes from another person, usually a cadaver. Before it's used, it is carefully treated to ensure it's super clean and free of living cells to prevent rejection. They're readily available from bone tissue banks, which save you from that extra surgical site.


Xenogeneic Graft: Similar to allogenic, but this bone comes from another animal species.


Synthetic Material: These grafts are made from artificial biomaterials that do the same job as real bone grafts. They're also known as bone substitutes.

The Stages of Dental Bone Graft Healing

When having a bone graft, your gums heal quickly, usually within the first week. But for the bone graft to fully integrate into your jawbone, it goes through a longer process.

A key thing to know about bone is that it can only regenerate if it has a solid foundation or scaffold to build upon. Imagine it as if you're training a plant to grow straight with a support stick. In the same way, the graft serves as that support system that will gradually attract new cells and blood vessels to make new bone. Now, let's outline the key stages essential for the complete healing and integration of the graft.

1. Inflammatory Reactions:

Immune Reactions

Right after the procedure, the body triggers an intense inflammation within the first four hours, which can last up to four days. Your blood vessels widen to bring in immune cells and inflammatory molecules to clean up the area and prepare for the next steps.

You might notice redness, swelling, and discomfort, but don't worry, that's normal and temporary. At the same time, a blood clot forms at the interface between the graft and the recipient site to stop bleeding and release growth factors. Moreover, it's a key player in ensuring the graft fully merges with the recipient site.

This phase is the most critical, as it's important not to disrupt the blood clot by touching the wound or rinsing the mouth too vigorously.

2. New Blood Vessels:

New blood vessels forming inside the bone graft

After the inflammation, blood vessels start growing into the graft, usually in the first few weeks. The type of graft material can affect how quickly this happens. When the graft has more tiny openings, like a sponge, blood vessels tend to grow into it faster. These blood vessels deliver the cells and nutrients needed for new bone formation.

3. Bone Resorption and Formation Cycle:

the bone remodeling cycle: Resorption and Formation

This is the slowest part and can take months, maybe even over a year. Here's how it works: cells called Osteoclasts eat away at the graft surface, while Osteoblasts create new bone. It's a remodeling cycle where the graft material gets gradually replaced, either partially or entirely, by new bone.

During this process, molecules and growth factors trapped in the graft are released, further enhancing the healing.

How Long Does the Healing Process Take?

Your soft tissues, including gums, recover pretty quickly. If you have dissolvable sutures—they vanish on their own within a week or two. But for other types of stitches, you'll need to see your dentist, usually between days 7 and 10, to have them removed manually.

Now, when it comes to the bone graft integrating with your jawbone, that takes a bit more time and can vary from person to person. Factors like age, overall health, and oral hygiene play a role. On average, it takes about 4 to 6 months, sometimes even longer. The goal is to wait until your jawbone is strong and stable enough for the next step, like getting dental implants.

Potential Complications

During the first four days, especially in the inflammation phase, you might experience some swelling, pain, and difficulty opening your mouth. Don't fret; these are normal and actually part of the healing process.

But, like with any surgery, there's always a slight risk of complications, although they're pretty rare. Here are a couple of things to watch out for:

  • Hematoma: This happens when blood leaks beneath the skin and surrounding tissue, causing a bluish bump. It's temporary and harmless, usually disappearing within 5 to 10 days. But if it persists longer, don't hesitate to talk to your dentist.

  • Infection: Sometimes, bacteria can enter the site and cause an infection, especially if oral hygiene instructions are not followed properly. This can affect both the donor and recipient sites.

  • Rejection: This is a small risk and occurs when your body doesn't recognize and accept the graft. As a result, blood vessels won't form over the graft, and it won't survive, breaking down quickly. This is more common with allogenic grafts, where the graft comes from another person.

Factors Influencing Bone Grafting Results

Several factors can have an impact on the speed and effectiveness of bone graft healing. These include:

  • Oral Hygiene: Maintaining excellent oral hygiene after the procedure is crucial. It helps prevent infections that can impair the success of the bone graft. Your dentist will give you specific instructions, like using antiseptic mouthwash, salt water rinses, and an extra soft toothbrush for the first few weeks. Following their guidance is key to a smooth recovery.

  • Smoking: If you smoke, it's essential to know that tobacco and its by-products contain harmful toxins that can hinder the healing process. Smoking narrows blood vessels, reducing the flow of nutrients and cells to the surgical site. Numerous studies have shown that smoking increases the risk of bone graft failure and may lead to less favorable outcomes. It is therefore essential to stop smoking both before and after surgery.

  • Overall Health: Certain medical conditions can weaken your immune system or affect blood flow, making healing more challenging. One well-known example is uncontrolled diabetes, which can alter blood circulation, immune function, wound healing, and increase the risk of infection—all factors that can get in the way of successful recovery.

  • Medications: Some medications, like corticosteroids and chemotherapy, can lower your immune response, increasing the risk of infections. It's important to discuss your medications with your dentist before the procedure to assess their impact on your graft's success.

Optimize Healing and Minimize Complications

While experiencing some post-procedure symptoms is normal, you can take steps to enhance your recovery and minimize discomfort. Here are some helpful aftercare tips:

  • Change your dressing regularly at home, using fresh gauze pads for your gums. If you experience bleeding, apply gentle pressure to the surgical site for a few minutes. If bleeding persists excessively, reach out to your dentist.

  • Follow all the medications as directed by your dentist, including pain relievers, mouthwashes, and antibiotics if prescribed.

  • Stick to a soft and warm diet, avoiding hot, hard, and crunchy foods during the first week.

  • Don't brush the surgical site during the initial week. Afterward, use a soft toothbrush with gentle motions to clean the area.

  • Rinse your mouth with the prescribed antiseptic mouthwash or salt water from the day after surgery until complete recovery. Be cautious not to spit vigorously in the first five days to protect the blood clot.

  • Avoid strenuous activities or movements that could disrupt the graft during the initial week.

  • Apply ice to the surgical site for 10 minutes every 20 minutes during the first 24 hours. This helps reduce swelling and pain in the days following the procedure. However, do not exceed the first 24 hours, as excessive cold can reduce circulation and slow healing.

  • Attend the follow-up appointments with your dentist to closely monitor the healing progress.