When I first started my practice back in the early 1980s, dental bone grafting was still a relatively complex surgical procedure that required live donor bone or bone marrow, usually harvested from healthy bone in another part of the patient’s body, in order to be successful. Dental implants were still a fairly new procedure, and the success rates of both treatments were variable at best, mostly due to higher risks of infection.
Today, dental bone grafting and implant placement are safer and more effective than ever before. Advances in synthetic bone materials have almost eliminated the infection risks that were so much more common when working with live donor bone. The process is much easier on the patient, requiring less surgical time and reducing post-operative pain to a minimum. In the last few years, the addition of bioactive proteins to these synthetic bone materials has improved grafting even further by speeding the process of wound healing and enhancing both bone and gum regeneration around tooth roots and implants.
Even for patients who are not considering an implant to replace a tooth that needs extraction, a bone graft now offers us the chance to preserve the shape and strength of the bony ridge long after the tooth is gone. This is important not only for the health and strength of the teeth surrounding the extraction site, but also for the possibility of implant, bridge, denture, or partial placement in the future.
The bony ridges of our jaws get their shape from actively holding the roots of our teeth in place. When a tooth root is extracted and not replaced with an implant or a bone graft, the ridge begins to resorb and reshape itself. Without that root tip, implant, or another section of bone to hold onto, the ridge will shrink in both height and width over time. The result over a period of years is often a section of bone that is narrow, short, and fragile. Implant placement becomes far more complicated in these areas, and sometimes is simply not possible.
But implant placement isn’t the only tooth-replacement option that can be complicated by thin, fragile bony ridges. Traditional dentures and partials always fit better when the bony ridge is thick and strong. Ideally, modern dentures and partials are now anchored with implants as well, in order to avoid the slipping, clacking, and messy adhesive solutions that were so common for our parents or grandparents. Even bridges placed over extraction sites can be esthetically compromised by bone resorption if the bone shrinks away from the suspended false tooth enough to show a gap. Simply put, thin and fragile bony ridges make every tooth replacement option more difficult, less comfortable, less successful, and sometimes even impossible.
A bone graft after an extraction may increase the cost of the procedure initially, but the cost of not replacing that bone over a period of years may add up to far more discomfort and expense than the initial savings justifies. I encourage everyone facing a tooth extraction to talk with your dentist about the pros and cons of proactive bone grafting in order to make the right long-term decision for your body. As always, current patients of mine are encouraged to call the office or bring their questions and concerns to any regularly scheduled dental appointment. Our goal is to offer you the most complete information about the potential long-term effects of all the treatment choices available to you, and to help you make the decision that best supports your health goals.