This procedure may also be referred to as osseous grafting. When teeth are lost, the “alveolar” bone that previously housed them begins to dissolve away in a process called “resorption.” Depending on the rate of resorption, the remaining bone may be insufficient to replace the missing tooth with a dental implant. If the missing tooth is to be replaced with a fixed bridge, the prosthetic replacement tooth (“pontic“) may look artificially large if the bone and gum tissue (“gingiva“) have resorbed significantly. One solution to this dilemma is to “graft” new bone onto the site. This process is sometimes referred to as “site development“, which refers to the fact that proper bony and gingival contours need to be re-established before ideal tooth replacement can be done. There are several ways of performing a bone graft. First, bone resorption can be prevented by packing the tooth socket with powdered bone graft material (called a socket graft, or ridge preservation) at the time of tooth removal (extraction). Bone grafting can also re-establish the height (by a limited amount) and width of alveolar bone that has already been lost following removal of a tooth. A block cortical graft involves attaching a solid piece of bone to the deficient area, and attaching it with fixation screws while it integrates into position over several months. Roots of the upper back teeth often project up into a hollow chamber inside the cheek bones, called the maxillary sinus. When any of those teeth are lost, bone may resorb from the sinus floor, as well as the other walls of the tooth socket. It can usually be regenerated in a procedure known as a sinus elevation (sinus lift). Bony defects sometimes occur around teeth with multiple roots. Such areas can often be treated by guided tissue regeneration (GTR).

Additional care you may need

The following are additional procedures which are commonly recommended at the time of, or after bone grafting procedures: fixed bridgework, dental implants, orthodontic treatment, removable dentures, and sedation procedures.

Other solutions

Generally, bone grafting is merely a step in a larger treatment plan. If the ridge is resorbed and the plan is not for dental implant placement, the step might be eliminated, but the cosmetic result may not be as desirable. If the plan is for a fixed bridge, the option to grafting is gum (gingiva) shaded porcelain to prevent the pontic (replaced tooth) from appearing too long. If the plan is for a removable partial denture, a resorbed ridge can be camouflaged with pink denture base material. If grafting is being done to allow placement of a longer implant, it may be possible to consider a short implant— if the bone is dense enough. Factors to consider may include how the implant will be restored (i.e. crown, bridge, denture), and how heavy of chewing forces it will be experiencing in function. There may be other considerations based on the patient’s unique situation. Your individual situation may include other treatment options, which your dentist may discuss with you.