Dra. Cléo Salustiano In this article
SummaryWhen does an implant need a bone graft?What is recovery from a bone graft like, and what care does it need?FAQRead nextBone Graft for a Dental Implant: When It Is Needed and How It Is Done
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A bone graft is needed when the bone lacks the height or width to hold and surround an implant. It is common after months or years without the tooth, because the bone is resorbed, and also after infections, difficult extractions and gum disease. In the back of the upper jaw, the maxillary sinus can reduce bone height and call for a sinus lift. The assessment uses a CT scan. Materials can be the patient's own bone, animal-derived bone, donor bone or synthetic materials, with a membrane. The graft can be done together with the implant or months before. Recovery means protecting the area, avoiding smoking, straws and vigorous rinsing, and watching for warning signs. In Mooca, Dr. Cléo Salustiano (CRO-SP 170844) sees patients every day, from 8 a.m. to 10 p.m.
A bone graft for a dental implant is needed when the bone in the area does not have enough height or width to hold the implant firmly and surround it completely. This is common after months or years without the tooth, because the bone that supported the root is gradually resorbed once it stops being stimulated. It also happens after infections, difficult extractions, advanced gum disease and, in the back of the upper jaw, because of the nearby maxillary sinus.
In clinical practice, many patients come in afraid of the word "graft," picturing major surgery. In most cases, a bone graft is done under local anesthesia, sometimes at the same time as the implant, using material that replaces bone or stimulates it to form. What changes is the total treatment time, not whether treatment is possible: missing bone is an extra step, not a roadblock.
Dr. Cléo Salustiano (CRO-SP 170844), a dentist in Mooca who works with oral rehabilitation and dental implants, explains when a bone graft is recommended, the most common types and what to expect during recovery. She sees patients in Portuguese, English and Spanish.
This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the dental implants page to learn how the treatment is done here and book your assessment.
When does an implant need a bone graft?
An implant needs a bone graft when exams show that the available bone is not enough to place the implant in the correct position, firmly and fully surrounded by bone. This assessment is done with a clinical exam and, in most cases, a CT scan, which shows the height, width and density of the bone in three dimensions, as well as the position of nerves and the maxillary sinus.
Bone loss after an extraction is the most frequent cause. Without the tooth root, the bone in that area stops being stimulated and shrinks, mainly in width, during the first months. That is why the longer you go without the tooth, the more likely the implant will need a graft. In some extractions, the dentist fills the socket with graft material right away to reduce this loss.
The back of the upper jaw is a special case: the maxillary sinus, an air-filled space above the tooth roots, tends to expand downward when teeth are lost, reducing the available bone height. The procedure to gain height in this area is called a sinus lift, and it can be done with different techniques depending on how much bone is missing.
Graft materials can be the patient's own bone, taken from another area of the mouth, processed bone of animal origin, donor bone from a tissue bank or synthetic materials. They are often combined and covered with a membrane that protects the area while new bone forms. The choice depends on the size of the defect, the area and the implant plan.
The graft can be done at the same time as the implant, when the bone deficit is small and the implant can still be placed firmly, or as an earlier step, when the defect is larger. In that second case, there is a wait of a few months for the bone to form before the implant is placed. The plan is based on the CT scan and explained before treatment.
| Situation | What is usually done | Time until the implant |
|---|---|---|
| Recent extraction, bone preserved | Implant placed directly or socket filled with graft | Immediately or after healing |
| Slight lack of width | Graft placed together with the implant | Same procedure |
| Larger bone deficit | Graft as an earlier step, with a membrane | A few months later |
| Little height in the back of the upper jaw | Sinus lift | Same procedure or a few months later, depending on the case |
| Bone loss from gum disease | Treat the gums, then plan the graft | Depends on disease control |
What is recovery from a bone graft like, and what care does it need?
Recovery from a bone graft is usually smooth when instructions are followed: in the first days there may be swelling, tenderness and slight bleeding, which tend to ease gradually. Cold compresses on the outside of the face in the first hours, taking it easy and the medications prescribed by your dentist help control the discomfort.
The most important care is protecting the treated area: do not chew on that side, avoid hard and very hot foods in the first days, do not rinse vigorously, do not spit forcefully and do not use a straw, so the blood clot or the material is not dislodged. People who have had a sinus lift are usually told not to blow their nose hard and to sneeze with their mouth open for a while.
Smoking is one of the biggest threats to a bone graft, because it reduces circulation and impairs bone formation. Quitting before and during treatment greatly improves the chances of success. Uncontrolled diabetes and some medications that affect bone also need to be reported and monitored, because they influence healing.
Signs that you should contact your dentist before your follow-up: pain that increases after the third day, swelling that grows instead of going down, fever, pus or granules of material coming out through the gum, and bleeding that does not stop with pressure. At follow-up visits, the dentist monitors healing and, at the right time, uses imaging to check whether the bone is ready for the implant.
In Mooca, Dr. Cléo Salustiano assesses the amount of bone with exams before proposing an implant and explains whether a graft will be needed, when and why. No dentist can guarantee the outcome of a bone graft, because bone formation also depends on each person's body. What planning does is choose the technique with the best chance in your case.
Why do I need a bone graft to get an implant?
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Because the implant has to be fully surrounded by bone and stable when placed. When the bone has lost height or width, usually from time without the tooth, a graft restores that volume. Without it, the implant could end up poorly positioned, partly exposed or without enough stability.
Does every implant need a bone graft?
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No. Many cases have enough bone and the implant is placed directly. A graft is recommended when the CT scan shows a lack of height or width. The longer you go without the tooth, the more likely you are to need one, so not putting off the replacement helps.
Does a bone graft hurt?
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The procedure is done under local anesthesia, so you do not feel pain during it. In the following days there may be swelling and tenderness, usually controlled with cold compresses and the prescribed medications. How much depends on the size of the graft and the technique used.
Where does the graft bone come from?
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It can come from the patient, taken from another area of the mouth, from a bone bank, from processed animal-derived bone or from synthetic materials. They are often combined and covered with a membrane. The choice depends on the size of the defect and the implant plan.
How long after a bone graft can the implant be placed?
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It depends. When the graft is small, it can be done together with the implant. When it is larger, there is usually a wait of a few months for the bone to form before the implant is placed. The right time is decided by the dentist with a clinical exam and imaging.
What is a sinus lift?
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It is a graft in the back of the upper jaw, where the maxillary sinus, an air-filled space, can reduce bone height. The procedure lifts the sinus membrane and places graft material beneath it, creating height for the implant. There are different techniques depending on the available bone.
Can a bone graft fail?
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It may not integrate as expected, especially with infection, movement in the area, smoking or healing problems. That is why post-operative care and follow-up matter. When this happens, it can be reassessed and redone. No dentist can guarantee the result.
Can smokers have a bone graft?
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Smoking reduces circulation and impairs bone formation, which raises the risk of graft failure. It is not an automatic ban, but quitting or cutting back before and during treatment is one of the things that most improves the chances of success.
What care is needed after a bone graft?
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Do not chew on the area, avoid hard and very hot foods, do not rinse vigorously, do not spit forcefully, do not use a straw and take the prescribed medications. After a sinus lift, avoid blowing your nose hard. Cold compresses in the first hours help with swelling.
Is it normal for graft granules to come out through the gum?
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Small granules may come loose in the first days without affecting the graft. But if it happens often, or comes with increasing pain, pus or fever, let your dentist know, because it may indicate that the area is exposed or infected.
I lost my tooth many years ago. Can I still get an implant?
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In most cases, yes, often with a bone graft to restore the lost volume. A CT scan shows how much bone there is and which technique is recommended. Time without the tooth usually adds steps, but it does not rule out rehabilitation.
Is there an alternative to a bone graft?
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In some cases, shorter or narrower implants, or different positions, avoid the need for a graft. In others, a tooth-supported bridge or a removable denture is an alternative. Each option has limits and advantages, and the recommendation depends on the bone, the bite and the patient's expectations.
Where can I get assessed for a bone graft for an implant in Mooca?
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In Mooca, Dr. Cléo Salustiano (CRO-SP 170844) assesses the amount of bone with exams and explains whether a graft will be needed before the implant. The office is at Rua Hipódromo, 1141, near Bresser-Mooca station, and is open Monday to Sunday, 8 a.m. to 10 p.m., via WhatsApp (11) 97409-7834. Care is available in Portuguese, English and Spanish.
