Added by Natalie Asmussen on | Reviewed by Katarzyna Gorska

What is a bone graft?

There are a plethora of reasons why you might need a bone graft. Your bones might have experienced trauma from a car crash, infection from a surgery, or you might even suffer from congenital malformations. 

 

Although it may sound like a daunting prospect, a bone graft is a safe procedure that is in fact quite common these days. Even so, it’s important that you understand this procedure to its full extent. That’s why in this article we will cover the following information:

  • What is a bone graft?
  • What does grafting mean?
  • What can I expect from bone graft surgery?
  • What are the types of bone graft?
  • What is a dental bone graft?
  • How much does a dental bone graft cost in the UK?

 

We will talk about what grafting means in general, while mostly focusing on bone graft for dental purposes. We hope that after reading this article, you’ll have all the information you need to speak with your doctor about this option for you, and feel confident in your upcoming procedure.

First, what does grafting mean?

In order to obtain periodontal tissue covers, guided tissue regeneration methods are used.
There are several types of materials that we use:

  • Bone materials
  • Bone substitute materials
  • Barrier membranes
dental implants with bone loss

There are different reason causing bone loss. Bones might have experienced trauma from a car crash, infection from a surgery, or you might even suffer from congenital malformations. Also when the tooth is missing for a long time it may lead to bone shrink.

Barrier membranes create a space where unwanted cells cannot penetrate. This enables the reconstruction of tissue. We divide barrier membranes into resorbable or non-resorbable. Non-resorbable requires removal after 4-6 weeks.

We divide bone materials into materials containing living cells and without living cells (autogenic/allogenic/ xenogenic materials). Bone substitute materials are natural (hydroxyapatite from algae) or synthetic (synthetic hydroxyapatite, HTR- polymer hard tissue “synthetic bone”, calcium phosphates).

Grafting is the process of transplanting healthy tissue, hard or soft, in order to repair damaged or diseased tissue.

Therefore, bone grafting is a surgical procedure where the healthy bone is taken from one part of your body and used to repair damaged bones in another part of your body. Almost every bone in your body can be repaired this way, and healthy bone is usually taken from your ribs, legs and hips. You may also receive a bone graft, not from the bones in your body, but from the bones of a cadaver, or maybe even synthetic materials.

Bone grafting is used to mend a wide variety of bones in the body, but one of its more common uses is a dental bone graft or a jaw bone graft. A dental, or tooth bone graft may be more aptly referred to as a tooth implant bone graft because many people need to have a dental bone graft procedure before getting a tooth implant. That’s because a tooth implant requires strong jaw bone in order to be inserted. And if your bone has been damaged or deteriorated, something that happens when teeth are missing, you’ll need a bone graft in your mouth to create strong enough bone to anchor the implant. We’ll discuss why you might need a bone graft for your tooth in more depth below.

Bone graft types

So now you know what a bone graft is, but did you know that there are various types of bone graft, not just in dentistry but in general also? Not only that, but there are different types of bone graft materials and different types of dental bone graft materials as well. Below we’ll go through the different types of bone graft and later we’ll go over the classification of bone graft materials.

Autographs are in fact considered to be the gold standard of grafts, since you don’t have to worry about donor availability or tissue rejection.

So what is an autograft bone graft? As you probably know, ‘auto’ means self, and as the name suggests, the autograft definition is tissue in your body that is transplanted from one part of your own body to another part of the body.

You may have also heard the term ‘local bone autograft.’ This usually refers to spine fusion, when tissue surrounding the area to receive the graft is harvested for the graft. However, a variety of local bone grafts have also been used in oral and maxillofacial reconstruction.

Autograft is the best material for bone regeneration, because it is biocompatible and bioactive. The material contains living cells.

Autograft can be made from ribs, tibia, retromolar triangle, hip bone and jawbone.

Allograft

bone grafting

There are 3 types of bone graft: Allograft- tissue transplant from a donor of the same species as the recipient, but genetically different, Xenograft- donor that is a different species than the recipient and Alloplast-non-biological material or heavily manipulated biological material from a different species

Remember when we mentioned above that you might get healthy tissue from a cadaver? Well, that’s pretty much how you would define allograft. An allograft, meaning tissue that is taken from cadavers, is taken from people who, before they passed, made the decision to donate their tissue post-mortem for just this purpose.

So what is an allograft bone graft?

A bone allograft is healthy tissue taken from a deceased donor of the same species, and since in this case we are talking about bone grafts, the tissue would be bone, as opposed to other tissue like skin.

Actually, it’s a bit more specific than that. The true allograft definition is tissue from a donor of the same species as the recipient, but not genetically identical-in other words, you can’t receive an allograft from yourself.

Bone allograft dental procedures are quite common in dentistry, and are shown to be useful and safe, as long as performed using best practices.

These best practices mean strict attention to detail when it comes to preparing the tissue before being transplanted to the donor. It must be ensured that the risk of disease transmission from donor to recipient and antigenicity (graft rejection) is minimized as much as possible. Here’s what that entails:

The human skeleton is made up of bone matrix. Bone matrix is a hard material that makes bones strong, and inside this hard material you will find all of the things that makes bones function, such as proteins and bioactive materials. The proteins in the donor’s bone must be sterilized and deactivated before being transplanted.

To do this, a demineralizing agent like hydrochloric acid must be used. After the proteins are degraded with the demineralizing agent, and the minerals gone, the osteoinductive agents (including collagen, proteins, growth factors, calcium phosphates and cellular debris) remain and make up the demineralized bone matrix or DBM that will be used as the graft.

Now, another problem with allografts is allograft rejection. 

There are three reasons why you might experience allograft rejection failure.

  • Hyperacute rejection
  • Acute rejection
  • Chronic rejection

Hyper acute rejection occurs right after the transplantation is completed, within a couple of hours or even minutes, and is caused by pre existing anti donor antibodies that are found in the blood of the recipient. What happens when the recipient’s body recognizes the donor’s antibody is ultimately that coagulation increases, causing inflammation and inadequate blood supply to the transplanted tissue (ischemia), and irreversible damage to the graft. To prevent this from happening, there is thorough screening for these anti donor antibodies.

Acute rejection happens sometime within the first weeks or months after a transplant has taken place. This type of rejection is the result of a mismatch in human leukocyte antigens and results in the death of the transplanted tissue. This type of rejection is usually prevented by immunosuppressive drugs that the recipient must take for the duration of their life.

Chronic rejection takes longer to develop, and might not even happen until years after the transplantation. Chronic rejection is promoted by arteriosclerosis, or graft vascular disease, along with graft tissue fibrosis. The result of this is ischemia, and cell death followed ultimately by graft failure. There is no therapy yet specifically for preventing Chronic rejection but it can be successfully prevented with combinations of immunosuppressive drugs that are aimed at preventing acute rejection.

Keep reading to learn about the differences between allograft vs autograft, xenograft and alloplast.

Xenograft

A xenograft is a type of tissue transplant where the tissue actually comes from a donor that is a different species than the recipient. This might sound strange, but xenografts are seen as having great potential especially in organ transplants when there are long waiting lists for organs. Currently, xenografts, such as skin from pigs, can be used to protect wounds on humans until the wound is able to heal.

Of course, not only does xenograft have the potential to help, it also has the potential to do great harm. The likelihood of rejection is greater than with alloplasts, and a wider range of diseases could potentially be transferred from donor to recipient. Trials tests are currently underway for transplants in rodents, and the idea to use heart transplants from other members of the primate family to humans, to prolong a human’s life who is on the waiting list for a heart transplant has been considered, but much more testing will need to be done first.

You may however, receive a bone graft made from Bio-Oss bone graft material, which is actually made from bovine sources. This is used in helping new bone to form.

Alloplast

An alloplastic is a graft of a non-biological material or a biological material from a different species that has been heavily manipulated. It can also be made from a type of glass that is made from hydroxyapatite, a mineral that naturally occurs in bone, making it bioactive and resorbable.

Bone graft materials

What is bone graft material normally? There are three types of materials used in bone grafts. Bone graft material can be:

  • Autologous: This is organic tissue, (in this case bone) that comes from the recipient’s own body. This is the material used in autografts as mentioned above.
  • Allograft: We mentioned allografts above as a type of bone graft. These bone grafts are normally made from demineralized freeze-dried bone.
  • Synthetic bone graft material: Dental work needing a bone graft can be completed with synthetic material too. This is where alloplasts come in, and are often made from artificial bone graft material like glass or plastics that contain hydroxyapatite and tricalcium phosphate.

There are various kinds or brands of allograft material, including:

  • Grafton bone graft material
  • DBX bone graft material
  • MTF bone graft material

These are all DBMs used in allografts. 

With all of these different types of bone graft materials, the question arises: Which is better?  Synthetic dental bone graft material, autologous material or allograft materia?  

When it comes to a dental bone graft material, the best bone graft material for a dental implant is case-specific. Some dentists prefer allograft dental implant bone graft material for larger spaces and alloplastic bone graft material for filling small gaps. You might find that it comes down to the dentist and material availability to decide what material your bone graft will be. You can ask your dentist about what they think about the different dental implants bone graft material as well.

The following video is meant for those in the medical field, but you might find it interesting if you want to see the doctors’ side of things, and you don’t mind the gory details and images. 

 

Dental bone graft procedure

Bone transplants can be intraoral (from inside the mouth) or extraoral (from another part of the body. If too much tissue is missing, the procedure may require an extraoral transplant.

Let’s talk a bit about procedure. The general procedure for bone grafting extraorally is as follows:

  • Anesthesia is administered so you will not feel any pain
  • A doctor or nurse will be in charge of monitoring your vital signs
  • The affected area will be cleaned
  • Your surgeon will make a cut in the skin and muscle around the bone that will receive the graft
  • At this point, in the case of an autograft, your surgeon will also make another cut to harvest your bone graft.
  • The surgeon will insert the bone graft between two pieces of bone that need to be repaired or grow together
  • If necessary, screws will be placed to secure the graft
  • The skin and muscle around the grafted bone will be surgically closed, as well as the site of the harvested bone.

If you are getting dental implants with a bone graft procedure, it might not be completed until your dental bone graft procedure recovery is completely finished, a process which can take several months to a year.

The bone graft procedure for dental work is quite common and although it might sound scary now, it will be well worth it in the long run if it means you can have implants to replace your missing teeth.

When the bone graft is necessary

You now know that a bone graft is done when you have a bone that is deteriorating or damaged and you need to help repair it with bone from another place or source. But in which specific situations might you need a bone graft? Specific to dentistry, the most common reasons why you might need a bone graft are:

  • Bone graft for dental implant
  • Bone graft after tooth extraction
Dentist during the surgery

Most common reasons why you might need a bone graft are bone graft for a dental implant or bone graft after tooth extraction

A tooth implant bone graft isn’t always necessary, but don’t feel bad if you need one. You are in good company. In fact, one study showed that half of the participants needed a dental implant bone graft for implant support.

A bone graft for a tooth implant is necessary when the patient receiving an implant doesn’t have enough healthy bone to support the implants. Someone might not have enough healthy bone due to bone development problems, gum disease, bone deterioration from missing teeth, or a face injury.

If you need a bone graft in order to get a dental implant placed, you might be wondering if you can get a bone graft and an implant done at the same time. You can get the procedures done simultaneously, in the case where the existing bone is strong enough to firmly hold an implant. In these cases, a bone graft is necessary for long-term support and not necessarily for immediate support.

Is a bone graft necessary after tooth extraction?

Now on to the second reason you might need an oral bone graft, and that is a dental bone graft after extraction. Bone grafts are often recommended after extraction, especially when a tooth implant is going to be replacing the missing tooth. These are called ridge preservation grafts, and they are placed into the socket right after tooth removal, so your graft can heal along with your socket. But even if you aren’t getting an implant, your dentist might recommend a bone graft anyway so that your jawbone doesn’t deteriorate where your tooth is missing.

You might also get a bone graft for wisdom teeth extraction. This will promote long-term health for your second molars. A wisdom tooth extraction bone graft is done as more of a preventative measure. The required care after a tooth extraction and bone graft will be very similar to care after an extraction that isn’t accompanied by a bone graft. The general care guidelines are:

  • Don’t touch the wound
  • Keep gauze in place for 30 minutes after surgery
  • Take painkillers as directed
  • Avoid rinsing or spitting for two days so as not to hinder the blood clot from forming
  • Do not smoke
  • Make sure to rest and not engage in intense activities
  • Use ice packs to reduce swelling if directed

Next, we will talk about bone graft for dental implants and healing time required, so you can know what to expect after your procedure.

Bone graft healing stages

The bone graft healing process will be different for everyone and that includes when it comes to tooth bone graft healing time as well, but the following are some of the things you should consider as part of a typical bone graft healing timeline:

Pain: Some pain and discomfort is normal after your bone graft oral surgery procedure. Your dentist will tell you how to manage pain, and they might even prescribe you pills for severe pain. The pain following you surgery should improve a bit more everyday. If it doesn’t improve you should call your dentist.

Bleeding: A small amount of bleeding should be expected after surgery. Make sure to not exacerbate bleeding by resting properly after surgery. You should call your dentist if bleeding does not subside.

Swelling: Bone graft for dental implant healing will involve swelling around your mouth, cheeks and even eyes. Don’t be alarmed if the swelling is at its worst three days after surgery. After that, however, it should get better and if it doesn’t you should call your doctor.

Bone graft healing time will vary, but in general it can take several months to a year to heal. During this time, proper care should be practised in order to promote recovery.

Bone graft risks

If you’re getting a bone graft, you may be wondering: ‘How long does dental bone graft pain last?’ or ‘What are the bone graft complications after a tooth extraction?’ Or in the case of a bone graft before an implant: ‘What are the common dental implant bone graft complications?’

man holding face

The bone graft success rate is really high, but there may be some complications after the surgery like swelling, pain, nerve damage or transplant rejection.

Even though the dental bone graft success rate is high (around 95%), as with any surgery, there are a number of dental bone graft complications that can arise. Bone grafting is a safe procedure when performed by a licensed professional. Oral bone graft complications are rare, but can include:

Bone graft resorption: In the early stages of healing, to some extent resorption is normal.
Swelling after oral bone graft: A certain amount of swelling after tooth extraction and bone graft around your mouth is normal and will peak around the third day after surgery. If swelling after a dental implant bone graft increases after three days, your doctor should be contacted.
Pain: Pain after a bone graft is normal after surgery. Dental bone graft pain should get a bit better every day.
Nerve damage: You may experience nerve damage after a dental bone graft, which can cause numbness, tingling and pain. Most nerve damage is only temporary, but if it lasts after 6 months it may be permanent.
Transplant rejection: This is when your body rejects the transplant.

After hearing these complications, you may be a bit worried, but as mentioned above, the oral surgery bone graft success rate is high, with a dental implant bone graft success rate of around 95%.

Bone graft aftercare

Caring for your oral bone graft is imperative if you don’t want to end up right back at the doctor’s office. Your doctor or dentist will give you instructions for how to take care of your healing mouth, but the general instructions after a bone graft are:

  • No touching the wound
  • No rinsing or spitting for two days
  • No applying pressure to the grafted area
  • No lifting your lip to look at the sutures
  • No smoking after a bone graft for two weeks if possible

Cost of a bone graft

British pounds in wallet

The cost of dental bone graft in the UK can be between £200 and £4,000

The dental bone graft cost in the UK can be anywhere from £200 to £4,000 it’s not likely to be covered on the NHS. If you need a bone graft for a dental implant, costs will be even more, and you may want to consider getting your dental work abroad, which we’ll talk more about below.

Is bone graft covered by NHS?

As mentioned above, a bone graft is most likely not going to be covered by the NHS. It may be partially covered by private insurance, otherwise, you’ll have to pay the full cost which ranges from £200 to £4,000. It’s possible that if your dentist decides it’s absolutely medically necessary for you to get a bone graft, NHS might pay for it partially, but again, your dentist will have to decide.

Bone graft abroad

If you need stronger bone in order to get dental implants, your bone graft cost will be even greater. That’s why you might want to consider getting your bone graft and dental implants abroad in places like Hungary or Poland.

Bone graft in Poland, for example, the average price of a bone graft will be just over £200, and your implant price will also be a lot less than it costs in the UK.

Check out the following table to see implant prices for some of the lowest prices in  Europe:

Poland

from 920 GBP

Hungary

from 840 GBP

Czech Republic

from 920 GBP

Slovakia

from 675 GBP

Spain

from 675 GBP

Compare the prices to the average cost of a dental implant in the UK which is £2,250, and that’s a lot of savings!

Also, just because treatment costs are cheaper abroad, doesn’t mean that the care is inferior. Treatment costs are cheaper simply because the cost of living in other countries is cheaper. Additionally, clinics abroad want Brits to visit them for dental work and they rely on good reviews to spread the word. We have an article all about dental implants where you can learn more about their costs and getting them abroad.

Bone grafting summary

Now you know the basics of a bone graft. It’s a relatively common procedure, performed when unhealthy or damaged bone needs to be made stronger. There are various types of bone graft and bone graft materials as well. You can have a bone graft that is taken from a different part of your own body which is called an autograft. You can also have a bone graft that is taken from a cadaver, called an allograft. Or you might even have a bone graft that is made from a synthetic material, called an allograft. 

Bone grafts are often performed after a tooth extraction in order to ensure the continued health of your jaw bone into the future, especially if you are planning on getting implants to replace your missing tooth. You might also get a bone graft before a dental implant, so that your existing bone is strong enough to keep the implant stable. You can also get a bone graft at the same time as a dental implant, in which case it would be to ensure bone health in the future. To ensure that your bone graft heals properly, make sure to follow your dentist’s post-care instructions and the guidelines outlined above.

FAQs

What is the best dental bone graft material?

The best material for a bone graft needs to be considered case by case. Sometimes the best material will be freeze-dried allograft (tissue from a cadaver that has been demineralized, also called DBM, demineralized bone matrix) and sometimes it will be bone from the patient’s own body. Some dentists even prefer alloplast (synthetic material) especially when it comes to supporting implants.

What do I do if my dental bone graft material is coming out?

Bone grafts are usually made from particulate bone, and have the consistency similar to sand. So it’s normal to notice that some small granules may become dislodged during the first days after your procedure. This is not cause for alarm and is indeed quite normal. Obviously, if it continues for a few days after surgery or worsens, you should make sure to contact your dentist.

Is a bone graft necessary for a tooth implant?

A bone graft is only necessary for a tooth implant when the patient’s jaw bone isn’t strong enough to support the implant, or the patient’s dentist decides that a bone graft should be placed now, to prevent weakening bone in the future.

Do I need a bone graft after a tooth extraction?

You may need a bone graft after a tooth extraction if you plan on getting implants placed later. Tell your dentist if you plan on getting implants and they will be able to advise you on the best course of action.

Sources

Bone allografts: A review of safety and efficacy’. Indian Journal of Dental Research. http://www.ijdr.in/article.asp?issn=0970-9290;year=2011;volume=22;issue=3;spage=496;epage=496;aulast=. Accessed 8 January 2020.

‘Bone grafts in dentistry’. Journal of Pharmacy & Bioallied Sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722694/. Accessed 8 January 2020.

‘The Allograft Defines the Type of Rejection (Acute versus Chronic in the face of an Established Effector Immune Response’. The Journal of Immunology. https://www.jimmunol.org/content/172/12/7813. Accessed 8 January 2020.

‘Chronic allograft rejection: A significant hurdle to transplant success’. Burns Trauma. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994504/. Accessed 8 January 2020.

‘Xenotransplantation: Science, Ethics, and Public Policy’. Institute of Medicine (US) Committee on Xenograft Transplantation. https://www.ncbi.nlm.nih.gov/books/NBK45531/. Accessed 8 January 2020.

‘Xenocraft’.Pediatric Critical Care. https://www.sciencedirect.com/topics/medicine-and-dentistry/xenograft. Accessed 8 January 2020.

‘Alloplastic Graft’. International Congress of Oral Implantologists. https://www.icoi.org/glossary/alloplastic-graft/. Accessed 8 January 2020.

‘Bone-grafting materials in implant dentistry’. Misch CE, Dietsh F. ohttps://europepmc.org/article/med/8142935. Accessed 8 January 2020.

‘Frequency of bone graft in implant surgery’. Maxillofacial Plastic and Reconstructive Surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819798/. Accessed 8 January 2020.

‘Success rate of dental implants inserted in autologous bone graft regenerated areas: a systematic review’. Oral Implantology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3530967/. Accessed 8 January 2020.

Natalie Asmussen

Natalie graduated from Universitat Rovira i Virgili in Spain.
Freelancer, Translator and Copywriter.
She was born and raised in the US, and now live in Spain, working as a freelance copywriter and translator. Natalie has over two years of full-time experience writing SEO articles, product descriptions, and articles for technical and travel blogs.

She has experience in the healthcare industry both as a Community Health Worker, and from her time working as a representative for the Affordable Care Act (more commonly known as ObamaCare) in the United States. She wrote medical and dental content for trusted healthcare information sites. Natalie is also volunteer at refugee mentor at the International Institute of Minnesota where she is a part of mentor for a newly arrived refugee families.

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