Bone Grafting

Bone augmentation is necessary in cases where the volume of the jawbone is not sufficient for an implant. It can be performed on both the upper and lower jaw and ensures that dental implants can be securely anchored. We often mix the patient’s bone with an artificial bone to restore the original contour of the jawbone and embed the implant for long term success.

When is a bone augmentation necessary?

Generally speaking, a dental implant should be surrounded by at least 2mm of bone on all sides. In many cases, the bone volume needed to support the dental implant is no longer there once the decision to insert a dental implant is made. This is due to the fact that the body reduces the bone volume in the part of the jaw where a tooth has been lost.

In the videos below you will find explanations of the options for bone augmentation that are available to you at our dental clinic in London. Bone augmentations and transplantations, where the bone is taken from and placed back into the oral cavity, can be performed on outpatients under local anaesthetic or light sedation. More comprehensive augmentation with bone extraction from the pelvis requires normal sedation.

Small bone augmentation around implants

Upper jaw bone construction

Missing bone volume can be compensated by means of minimally invasive surgery, by filling a small part of the paranasal sinuses with bone material (known as a sinus lift). This develops a sufficient bone layer for the placement of dental implants. The procedure is performed through the oral cavity and leaves no external scars. There are two types of such procedures, the internal sinus lift and the external sinus lift.

Bone construction in the lower jaw — autologous bone graft
When there is a serious lack of bone in the lower jaw we can transplant bone from the wisdom tooth region to the area where the bone is needed. The missing bone in the wisdom tooth region grows back completely and the transplanted bone fuses and can now support an implant.

Extensive bone augmentation

If there is pronounced bone loss an extensive re-structuring of the jawbone must first be performed before an implant can be placed. The removal of small parts of the hip bone (known as the iliac crest) is a safe way to gain enough of the body’s own bone. The pelvic surgery is minimally invasive under sedation and is performed in co-operation with a plastic surgeon. The pieces of bone obtained from the iliac crest are attached to the jawbone using small titanium screws. Each bone graft must be completely covered with oral mucosa (membrane) to ensure safe healing. After several months of healing the dental implants can be placed safely into the newly grown bone.

Bone augmentation with artificial material

Bone block transplants to create new bone for front teeth

Bone block for bone augmentation

Possible materials for bone construction

Autogenous bone (originating within the body) can be taken sufficiently from different parts of the body and is very suitable for the restoration of jaw defects. There is no risk of infection for the patient and therefore the bod's own bone is superior to all other materials.

Natural bone (or allogenic bone) replacement material can be taken from animals. The material used is a medical product which is CE certified (conformity with health, safety and environmental protection standards for products sold within the European Economic Area). Natural bone replacement material is suitable for the filling of small jaw defects, or as additional material for mixing with autogenous bone.

Synthetic (artificial) bone replacement material consists of calcium-based ceramics or so-called bioactive glasses. It is offered as granules and due to the low stability, it is only used for small jaw defects.
In each case, the decision on which material is to be used should be made after the necessary diagnostic procedures (clinical and radiographic examination) has been carried out and explained by your treating dentist. In summary, autogenous bone in connection with allogenic bone is still the most compatible and predictable method for bone augmentation.

Which material is the right one?

Dental implants are an elegant and secure way to safely and permanently replace lost teeth. Often, however, the treating dentist already determines at the first examination that there is too little jawbone for a dental implant and that augmentation is necessary. Should artificial bone replacement material fill the defect or is the transfer of the patient's own bone the best way to restore the jaw? The answers to these questions are complex and have to do justice to the individual patient's case.

The insertion of dental implants is comparable to the insertion of a dowel into a wall. If the wall is too thin or the dowel too thick, it breaks out of the wall and what should be held by the dowel falls down. Similarly, dental implants used in a too thin or too weak jawbone can fail to bear the load of the restoration. The implant loses its supporting bone walls under the chewing load and must be removed after a short time. The desired therapeutic success — solid teeth — does not happen.

The lasting success of dental implants is thus highly dependent on the extent of the existing jawbone. As a general rule, a dental implant should be surrounded on all sides by a bone layer of at least 2mm thickness. Often, however, at the time of the decision for a dental implant, this bone volume is not present, because the body reduces the thickness of the jawbone as it is not needed if a tooth is missing.

Materials available for bone augmentation:

To replace lost bone, the following materials can be used:
• The body's own bone
• Natural bone replacement materials
• Synthetic bone replacement materials

The body's own bone can be obtained sufficiently from various parts of the body. In the oral cavity, these include the implant's drill hole, the mandibular (lower jaw) and chin area. Outside the oral cavity, larger amounts of endogenous bone (originating from within the body) can be taken from the anterior pelvic bone (hip). The body's own bone is very well suited for the restoration of jaw defects. There is no risk of infection for the patient and the risk of immunological graft rejection is excluded as it is exclusively endogenous tissue. The body's own bone is therefore superior to all other bone regeneration materials and today remains the gold standard in bone augmentation.

Disadvantages, however, are the limited availability and the need for a further removal point. Usually, either bone particles or whole bone blocks are used. The fixation is done with small titanium or steel screws, which are usually removed after the healing time of the bone graft (about three to four months).

Natural bone replacement materials are derived from animal material (bone and connective tissue) and are available predominantly as granules (ground bone) or as blocks. The most common donor animals are cattle and pigs since the bones of these animals are similar to those of humans. However, preparations of human origin are also available. The products used as medical devices must comply with the requirements of the Federal Institute for Drugs and Medical Devices (BfArM). To eliminate the risk of transmission of infectious diseases such as HIV or hepatitis and immunological rejection, these materials are sterilised and preserved. However, this also alters the biological properties of the materials and may result in increased degradation after surgery. The healing phase after the bone is built up is longer than with the body's own bone (about four to six months).

Natural bone substitute materials are suitable for the filling of smaller jaw defects, or as an admixture to the body's own bone. Synthetic (artificial) bone substitutes consist mainly of calcium-based ceramics or so-called bioactive glasses. They are offered as granules and are due to their lower stability only for use in smaller jaw defects.

As medical devices, they are also subject to:

• the Medical Devices Regulations 2002 (SI 2002 No 618, as amended)
• the General Product Safety Regulations 2005 (SI 2005 No 1803)
• Consumer Rights Act 2015

These are safety regulations under the Consumer Protection Act 1987 and, as such, the Medicines and Healthcare products Regulatory Agency (MHRA) is supervising the use of these products.
Which material is used in the specific case should be determined after the necessary diagnostic measures (clinical and x-ray examination) and the appropriate explanation by the attending dentist. In summary, the body's own bone remains the most predictable method of jawbone construction.

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Lecturer of the Academy of Practice and Science

Implantologist certified by the German Society for Implantology (DGI)

Specialist certified by the General Dental Council and the German Society of Dental Prosthetic and Dental Material

Fellow of the Royal Society of Medicine

Registered Specialist with the General Dental Council

University lecturer at the Christian-Albrechts-University, Kiel, Germany

All-on-4® Competence Center 2019/2020

Certified training centre for Implantology (DGI)

European Association for Osseointegration

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Wimpole Street Dental Clinic
  • 55 Wimpole Street
  • Marylebone
  • London
  • W1G 8YL
  • T.020 3745 7455

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