Bone grafting for dental implants: what to expect

Bone grafting for dental implants rebuilds jawbone that has been lost, so that an implant has enough healthy bone to sit in. It is a common, planned step in implant treatment, not a sign that something has gone wrong. This guide explains why a bone graft may be needed, the main types, what happens on the day, bone graft recovery and how long healing takes before an implant, so that you know what to expect if your dentist in Chandigarh suggests one.

For an overview of the whole implant journey, read our complete guide to dental implants in Chandigarh.

Why a bone graft may be needed

An implant needs bone around it on all sides. Bone can be too thin or too low for an implant because:

the jawbone shrinks after a tooth is removed, and keeps shrinking while the gap is left
gum disease or a long-standing infection has destroyed bone
an injury or a difficult extraction damaged the bone
a denture worn for many years has pressed on the ridge
in the upper back jaw, the sinus leaves little bone height

A bone graft is not needed for everyone. Your dentist measures the bone on a CBCT (3D) scan and tells you whether grafting is needed, and why. Read more on our bone loss page and in dental implants with bone loss: what are your options?

Types of dental bone graft

Grafts are described by where they are placed and what they are made of.

By where they are placed

Socket preservation: graft material is placed in the socket straight after an extraction to limit shrinking of the ridge. A systematic review found that, on average, grafting the socket reduced bone loss in width and height compared with extraction alone. See dental implant after tooth extraction: immediate or delayed placement?
Ridge augmentation: graft particles are added along a thin or low ridge and covered with a protective membrane, so that new bone can form. This is also called guided bone regeneration.
Block graft: for larger defects, a small piece of bone is fixed to the jaw with tiny screws and left to join the jaw.
Sinus lift: in the upper back jaw, graft material is placed under the lifted sinus lining. Read sinus lift procedure for implants: what to expect.

Illustration: socket preservation after an extraction, ridge augmentation with particles and a membrane, and a block graft fixed with small screws. Lower jaw seen from the cheek side, simplified. Not a patient photograph.

By the material used

Autograft: your own bone, usually taken from another area inside the mouth
Allograft: human donor bone from a licensed tissue bank
Xenograft: bone of animal origin, often bovine, that has been processed for medical use
Alloplast: a synthetic, bone-like material

Each material acts as a framework that supports new bone growth. Depending on the material, some graft particles may remain within the new bone. Your dentist will explain which one is suggested for you and why.

What happens on the day of a bone graft

Planning first. Your dentist reviews your medical history and medicines and studies the X-rays or CBCT scan.
Numbing. The area is numbed with local anaesthetic. If you feel anxious, ask about sedation options; see our IV sedation page.
Access. A small cut is made in the gum and the gum is gently moved aside to show the bone.
Grafting. The area is cleaned and the graft material is placed where bone is missing.
Protection. A membrane is often placed over the graft. Many membranes dissolve on their own; some need to be removed later.
Stitches. The gum is closed with stitches and you are given written aftercare instructions.

In some cases the implant is placed at the same visit as the graft. In others, the graft heals first and the implant is placed later.

Bone graft recovery: the first two weeks

Tenderness, swelling and bruising are normal and usually settle within one to two weeks. In the first few days you may notice a few small granules, like grains of sand, coming from the site. This is common, but tell your dentist if a lot of material comes out. Follow the written instructions you are given. Common advice includes:

take any medicines exactly as prescribed
use cold packs on the outside of the face and rest with your head raised
eat soft food for a few days and chew on the other side
keep the area clean as advised, without spitting, rinsing hard or touching the stitches
avoid smoking, vaping and alcohol while the area heals; see smoking and dental implants
avoid heavy exercise for the first couple of days

Call your dentist if you have a fever, pus, swelling that keeps increasing, or pain that gets worse instead of better.

How long before an implant can be placed?

Healing time depends on the size and type of graft. Cleveland Clinic notes that a graft needs at least three months to heal, and that a large graft may take nine to 12 months. The American Academy of Periodontology gives a usual range of four to 12 months before implants when they are not placed at the same time. Cleveland Clinic notes that the implant is usually placed within six to 12 months after the graft has healed.

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