Dental Bone Grafting in Turkey

Dental Bone Graft Overview

One of the most important factors for the success of dental implant treatment is the presence of sufficient bone support in the area to be treated. If there is no bone support with sufficient width and length in the area, implant treatment cannot be successful. For this reason, the first and most important step in patients with bone deficiency and implant treatment is to eliminate the bone deficiency problem.

Bone grafting is often preferred in patients who will undergo dental implant treatment. In case of bone loss in the jawbone, a series of procedures are applied to create bone in the lost area. The bone grafting procedure can be performed using bone tissue taken from the patient's own body, grafts obtained from animal sources or synthetic grafts.

Bone grafting, which is a surgical procedure, should be performed by an experienced and specialized dentist. In cases where the patient's bone tissue is used, graft material is usually taken from under the jaw. A solid structure is created on the jawbone to ensure suitability for implant treatment.

Bone grafting is an effective treatment used to create a suitable jawbone for implant treatment. Thanks to the bone grafting procedure, jawbone deficiency problems of patients who will receive dental implants are eliminated and a healthy and durable foundation is prepared for dental implants.

Candidates and Uses for Bone Grafting

Bone graft treatment is used to compensate for the loss of jawbone due to various reasons and to create a suitable basis for dental implant treatment. Some conditions that require bone grafting can be listed as follows:

• Long-term tooth loss: It is possible for the jawbone to weaken in the area where teeth are lost due to various reasons and where there is a long-term lack of teeth. Adding bone to the weakened area with a bone grafting procedure can strengthen the jawbone.
• Jawbone deficiency: The jawbone may be deficient due to congenital structural problems, genetic factors or trauma-related deficiencies. In this case, a bone grafting procedure can be used to strengthen the jawbone.
• Periodontal diseases: Damage to the gums and surrounding tissues may occur due to periodontal diseases. In case of bone loss in the jawbone, bone grafting can be applied to compensate for these losses.
• Incorrect prosthesis use: Loss of jawbone may occur due to toothlessness or the use of inappropriate prostheses. As a result of treating these losses with bone graft, it may be possible to provide a suitable environment for implant treatment.
• Conditions due to genetic factors: People with weak jawbone structure due to genetic reasons can be treated with bone graft treatment to strengthen the jawbone.
• Accidents or traumatic events: Damage to the jawbone can occur due to accidents, injuries or traumatic events. Bone grafting can be applied to correct the damaged area.

Some of the advantages of bone grafting treatment are as follows:

• Missing or damaged bone tissue can be repaired and reconstructed with bone grafting.
• It can provide the bone tissue needed to place dental implants.
• It can correct bone loss and deformity.
• It helps to improve oral and dental health.
• It can play an important role in the process of restoring functional loss.

Dental Bone Graft Types and Pain During Treatment

The types of dental bone graft are determined depending on the needs and general health status of the patient. Dental bone graft types are as listed below:

Autogenous grafts: Highly compatible autogenic grafts are made by taking tissue from the patient's own body.

Isogeneic grafts: Isogeneic grafts, in which tissue compatibility is extremely important, are applied by taking similar tissues from another living being.

Allogenic grafts: Allogeneic grafts, which are usually obtained from banks, include donor tissues with different genetic structures from the same species.

Xenogeneic grafts: They are usually of animal origin and are tissues taken from different species.

The types of dental bone graft listed above are used to eliminate the loss of jaw bone and to provide suitability for implant treatment.

Dental bone grafting usually causes minimal pain and discomfort. On the other hand, the pain felt during dental bone grafting treatment may vary depending on the pain threshold, sensitivity to the surgical intervention and the application site.

Dental bone grafting is a procedure usually performed under local anesthesia. The application site is numbed with local anesthesia, which prevents pain during the operation. Patients may experience mild to moderate discomfort after the procedure. Post-procedure discomfort may vary depending on the complexity of the operation, the type of dental bone graft used and the general health of the patient.

Painkillers and anti-inflammatory medications prescribed by dentists can be used to reduce pain and discomfort after the procedure. In this way, the comfort of the healing process can be optimized.

The recovery time after dental bone graft treatment may vary depending on the patient-specific structural features and the type of dental bone graft used. Pain and discomfort usually decrease within a few days, and the healing process progresses smoothly.

Comparing Autograft, Allograft, Xenograft and Alloplastic Bone Grafts

Dental bone grafts fall into four groups by where the material comes from: autograft is the patient's own bone, allograft is processed bone from a human donor, xenograft is processed bone mineral of animal origin, and alloplastic grafts are synthetic materials (PubMed 41711003). Their biology differs, yet a meta-analysis of sinus floor and ridge augmentation found no evidence that the patient's own bone is superior to bone substitute materials for implant survival; in ridge augmentation, survival was 97.4% with substitutes and 98.6% with autogenous bone (PubMed 24977257).

Starting fees on the current price list: autograft from €830 (from the ramus); allograft from €340 (0.5 cc); xenograft from €470 (1 cc).

The materials are often combined. Small amounts of the patient's own bone chips mixed with a slowly resorbing xenograft or alloplast, protected by a membrane or mesh, improve contour stability in sinus lifts and ridge augmentation (PubMed 41711003). The steps of grafting and the healing time before the implant are covered in our article on what a dental bone graft is.

Sinus Lift by the Lateral Window or the Crestal Approach

A sinus lift, or sinus floor elevation, is the bone graft procedure used when the bone left in the back of the upper jaw is too short for a standard implant, and it raises the sinus membrane to make room for the implant (PubMed 25123761). There are two approaches. The lateral window, often called the open sinus lift, reaches the sinus through a window opened in its side wall. The crestal or osteotome approach, often called the closed sinus lift, raises the sinus floor through the implant site itself with osteotomes of increasing diameter. The crestal route is less invasive than the lateral window, and more than nine out of 10 patients who had it said they would undergo it again (PubMed 25123761).

Remaining bone height largely decides which approach fits. In a systematic review of 25 osteotome studies covering 3,092 implants, the failure rate was 3.85%; an initial bone height under 4 mm affected implant success, while heights above 4 mm did not (PubMed 24818194). A meta-analysis of 11 lateral window studies with at least five years of follow-up, in patients with 6 mm of residual bone or less, found a weighted annual implant loss of 0.43%, with no difference between implants placed at the same time as the lift or later, or between the patient's own bone and bone substitutes (PubMed 30624789).

Implant survival is similar with both approaches, and a meta-analysis of 17 studies found no statistically significant difference between direct and indirect sinus lifts (PubMed 36511050). Their complications differ. Across 74 studies and 4,411 procedures, membrane perforation and sinusitis were more frequent with the lateral approach, while some studies reported benign paroxysmal positional vertigo after the crestal approach (PubMed 35737681). With the crestal technique, membrane perforation was reported in 3.8% of patients and postoperative infection in 0.8% (PubMed 25123761). Who is a candidate and what recovery involves are covered in our article on what a sinus lift is and who it suits.

How Is Tooth Bone Grafting Performed?

• The first step of the dental bone graft treatment is to evaluate the general health status of the patient and to determine the deficiencies in the jawbone.
• Local anesthesia is applied to the patient.
• The appropriate graft material is selected and placed in the area with bone deficiency.
• After the graft, which is used to support and strengthen the jawbone, is fixed, sutures are applied and the procedure is completed.
• Bone graft treatment is usually performed under local anesthesia. Sedation may be applied if deemed necessary for the patient.
• The duration of the bone grafting procedure may vary depending on the type of graft used and the complexity of the procedure.

When the graft is protected with a barrier membrane (guided bone regeneration), whether that membrane stays under the gum during healing affects the result. In a meta-analysis of eight studies, edentulous ridges without membrane exposure achieved 74% more horizontal bone gain than ridges where the membrane became exposed (PubMed 29368353).

Treatment Process

1. 01Evaluation: General health and the jawbone deficiency are assessed.
2. 02Anaesthesia: The area is numbed with local anaesthesia, with sedation added if needed.
3. 03Graft & Closure: Graft material is placed in the deficient area, covered with a membrane, and the area is sutured.

Tooth Bone Graft Healing Time

The healing process of a dental bone graft can vary depending on the patient's general health condition, the graft material used, how well the patient follows the dentist's recommendations after the procedure and various other factors. Mild pain, swelling and bleeding may occur in the first 1 to 2 weeks after the procedure. The patient's comfort can be optimized during this period with the regular use of medications prescribed by the dentist.

Within a few weeks to a few months after the dental bone graft procedure, the process of integration of the graft material into the jawbone begins. A period of several months is needed to ensure long-term healing. Once this process is complete, a dental implant can be applied.

During the healing process after bone graft treatment, the treatment area should be kept clean and necessary oral care should not be neglected. Failure to pay due attention to oral hygiene after the procedure may lead to infection and various dental problems. During the first few days following the bone graft treatment, soft foods should be consumed and very hot drinks should be avoided.

It is recommended to sleep with the head elevated for the first 3 days to prevent blood accumulation at the incision site. The desired bone density in the bone grafted area is usually reached within 3 months after the procedure. During this period, the check-ups requested by the dentist should not be missed.

Working Mechanism of Bone Grafts

Bone grafts are used to replace or regenerate missing bone tissue on the jawbone or gums. Bone grafts work in various ways to stimulate bone regeneration.

• When bone graft material is placed in the area of bone deficiency, it stimulates new bone formation in the area. The graft material combines with the surrounding living tissues and promotes the formation of new bone tissue.
• Bone grafts often act as a scaffold to replace missing bone tissue. They can be used in procedures such as implant placement or as a supportive material to prevent bone loss after tooth extraction.
• Bone grafts encourage bone cells to settle and multiply in the missing area. This depends on the graft material being compatible with the surrounding living tissues and the bone cells being able to easily settle into the graft material.
• Bone grafts can trigger bone regeneration and accelerate the body's natural healing process. The graft material interacts with surrounding cells and can stimulate inflammatory responses and tissue regeneration.
• Bone grafts can help to increase the volume and density of missing bone tissue. This can compensate for bone loss in the jawbone or gums. Structures such as implants and dentures can then be placed on a more solid foundation.