Procedures

Bone grafting

Disadvantages & risks

• If you are taking bisphosphonate medications (a drug to reduce the effects of osteoporosis), you may be required to go off of the medication for a period of time prior to undergoing bone grafting procedures. Bisphosphonates decrease the blood circulation in the head and neck bones, possibly enough to impair healing and invite infection following surgical procedures like tooth extractions. This is especially true if you receive the medication intravenously, or are also taking immunosuppressive drugs like corticosteroids.
• If you have a history of radiation treatment that may have involved the head and neck, you may be at risk for developing osteoradionecrosis following surgical procedures like bone grafting. Essentially, this means "bone death" secondary to radiation, which destroys small blood vessels that supply the bone. Even if you don't develop osteoradionecrosis, the bone graft itself may fail to integrate with your bone due to poor blood flow to the graft site.
• Bone grafting requires the use of anesthetic, which has risks of its own. Your dentist may provide you with specific information.
  Learn more: Procedures › Local anesthetic
• Bone grafting, like any surgical procedure, has general post-surgical risks: pain, swelling, bruising, bleeding, and infection. Most of the early symptoms (pain, swelling, bruising) can be managed with anti-inflammatory medications (check with your physician or dentist before taking any unprescribed medications). Your dentist may provide other specific instructions for addressing your symptoms following tooth extractions. Frequently, dentists will prescribe pain relievers for bone grafting procedures, but the specific medication will depend on the age and health history of the patient. Generally pain is not severe following bone grafting. Bleeding after bone grafting procedures is normally minimal. If you feel you're experiencing an abnormal amount, apply direct pressure to the area and call your dentist.
• Frequently, dentists will prescribe antibiotics to be taken a day or so before the procedure through 7 to 10 days after the procedure to minimize the likelihood of developing an infection. Infection is the most common way for bone grafts to fail. Failure by infection means a failure for the graft to be integrated into the host (i.e. "your") bone.
• Bone grafting in a few areas of the mouth can be accompanied by the risk of nerve injury. If this occurs, the worst case scenario includes permanent numbness in the area supplied by the injured nerve. The incidence of this is relatively low, but you should discuss the possibility with your dentist ahead of time.
• You may experience loss of, or reduced chewing function in the surgical area(s), which is normally temporary. You may experience limited ability to open your mouth, which is also normally temporary.
• Additional risks depend on the type of bone graft procedure you're having done, and the area of the mouth where the graft is required. If the graft involves use of powdered bone materials only, there will be no "donor site" surgery, and hence no morbidity (i.e. complications) associated with harvesting the material. If the surgical plan involves using your own bone for all, or part of the graft, there will be a second surgical site—the "donor site", which may also produce post-operative pain, swelling, infection, bleeding and bruising.
• The degree to which the goals of grafting are met can determine whether the procedure is successful or not. For example, the pre-operative goal may be to obtain a wide enough bony ridge to place an implant. Although the graft may integrate, and some additional width may be obtained, it may not be enough width to place the size of implant that is desired, and a secondary grafting procedure may be necessary. Your dentist will be able to identify specific risks that accompany your unique situation.
• Your health history may affect the prognosis for a graft, and may even present contraindications for surgery of any kind, including oral surgery. Among the health risk factors for bone surgery are a history of poorly controlled diabetes, radiation to the head or neck, conditions producing abnormal bone metabolism (such as osteoporosis or altered parathyroid gland function), and certain medications, like bisphosphonate drugs as mentioned. Your dentist should review your health history carefully with you prior to performing bone grafting procedures.
• Although the risks of using bone graft material from a tissue bank are thought to be extremely low, due to donor screening and rigorous purification procedures for the donated bone, there is still a theoretical pathway for disease transmission from donor to host. Generally, the benefits of using tissue bank bone are considered to greatly outweigh the risks on this point. You should discuss this topic in more detail with your dentist, or research the topic other ways if you are uncomfortable with the use of tissue bank bone.