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Bone grafting

Also known as: Bone augmentation, Ridge augmentation, Guided bone regeneration

Adding bone or a bone substitute to a deficient jaw ridge so that an implant can be placed in, or surrounded by, an adequate volume of bone.

Key facts

Graft materialsGrafting materials fall into four groups: autografts taken from the patient, allografts from human donors, xenografts of animal origin, and synthetic alloplasts such as calcium phosphate ceramics and bioactive glassesVerified spec[1]
Clinical evidenceThe ITI consensus on localised alveolar ridge defects states that survival rates of implants placed in regenerated bone are comparable to survival rates of implants placed in native boneVerified spec[2]
Surgical approachThe same consensus reports that augmentation using autogenous bone blocks, with or without membranes, gives higher gains in ridge width and lower complication rates than particulate materials, and that membranes are indicated when particulate materials are usedVerified spec[2]
LimitationsVertical augmentation has substantially lower predictability and a substantially higher complication rate than horizontal ridge augmentation; the consensus was not able to demonstrate the superiority of any one augmentation technique over another on the basis of implant survival ratesVerified spec[2]
Main stagesAssessment of the shape and size of the defect on imaging; the graft procedure, either at the same visit as implant placement or as a separate earlier operation; a healing period, which for larger defects is commonly measured in months; then implant placement or restoration. Whether grafting and placement can be combined depends on how much of the implant surface would otherwise be uncovered.
AlternativesGrafting is not the only response to a deficient ridge. Short or narrow implants, tilted implants, and anchorage in remote sites such as the zygoma are all used specifically to avoid it, and which route is reasonable depends on the anatomy rather than on preference.

Overview

Bone grafting rebuilds a ridge that has lost width or height so that an implant can be placed with bone around it. The materials divide into four families — the patient’s own bone, human donor bone, animal-derived mineral and synthetic substitutes — and they behave differently, but consensus reviews have not been able to show that any single technique produces better implant survival than another. What the evidence does support is that implants placed in regenerated bone survive comparably to implants in native bone, which is the question most patients actually want answered. The honest caveat is directional: building a ridge outwards is considerably more predictable than building it upwards, and vertical augmentation carries a substantially higher complication rate. Grafting is also not the only option — short implants, narrow implants, tilted implants and remote anchorage all exist partly to avoid it, and which route makes sense can only be judged from imaging and examination.

This is general information. Whether any treatment suits you depends on clinical examination, including imaging — no website can determine that.

Sources

Numbers match the citations beside each claim above.

Clinical evidence

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