What is a bone graft, and what is it for?
In a bone graft (augmentation), bone or a bone substitute is placed where the jawbone is not sufficient, to increase the amount of bone. As the patient information from Cambridge University Hospitals explains, an implant needs enough bone at its site; the graft helps to place the implant in the right position.
The material placed is not itself the new bone. Cleveland Clinic compares it to a scaffold along which your own bone tissue grows and renews itself: the material holds the space, and your body does the actual repair.
Why does the jawbone shrink after tooth loss?
When a tooth is removed, the bone around the socket gradually breaks down. The extent has been measured: according to a systematic review in Clinical Oral Implants Research (Tan and colleagues, 2012), bone width decreased by 29 to 63 percent and bone height by 11 to 22 percent six months after extraction. Bone is lost fastest in the first three to six months, then more slowly.
Extraction is not the only cause. According to Cleveland Clinic, gum disease (periodontitis) can also destroy bone, and a graft may then be needed as well. For international patients who have had a gap for a long time or have worn a denture for years, this is one reason why a graft is needed more often.
How is the amount of bone assessed on the CBCT scan?
According to Manchester University NHS Foundation Trust, cone-beam computed tomography (CBCT) is a dental X-ray examination that produces a three-dimensional image of the teeth and jaws. The same source says it is particularly useful for implant planning; the radiation dose is higher than that of a standard dental X-ray but well below that of a medical CT scan.
The three-dimensional image allows us to assess:
- the height and width of the bone
- the distance to the nerve canal in the lower jaw and to the sinus in the upper jaw
- if a graft is needed, in which direction and to what extent bone is missing
A panoramic X-ray (OPG) from home helps with the preliminary assessment, but it is a two-dimensional image. Whether a graft is needed can therefore only be confirmed with the CBCT scan on site.
Which materials are used?
Cleveland Clinic divides the materials into four groups by their origin:
| Material | Origin |
|---|---|
| Autograft | Your own bone from another part of your body |
| Allograft | Processed human bone from a licensed tissue bank |
| Xenograft | Processed bone of animal origin (usually cow or pig) |
| Alloplast | Laboratory-made synthetic bone-like material |
According to Cambridge University Hospitals, sterilised, processed bovine bone is the most common graft material; it is used alone or mixed with your own bone chips and covered with a membrane that dissolves in the body over time. Your own bone can be used as small particles or as blocks taken from the hip, the jaw or the chin, and can sometimes also come from a human bone bank. According to Guy’s and St Thomas’ NHS Foundation Trust, taking bone from the hip is done under general anaesthetic with a hospital stay.
Which material is used is decided by the dentist from the size and position of the defect. If you do not want material of animal origin for religious or personal reasons, please say so before planning.
What is the difference between socket preservation and augmentation?
Both serve the bone but are used at different times:
- Socket preservation: straight after the extraction, the empty socket is filled with material and, according to Cochrane, covered with gum or a membrane to reduce bone loss. The Cochrane review notes that the evidence for less bone loss compared with extraction alone is limited and that no clear difference between the materials could be shown. How an extraction works is explained on our tooth extraction page.
- Augmentation: used when the bone is already narrow or low. Cambridge University Hospitals names guided bone regeneration with particles and a membrane, block grafting with a block of bone, and ridge splitting.
At the back of the upper jaw, bone height is often limited by the sinus. The procedure for that is explained in our guide sinus lift.
Is the graft done together with the implant or before it?
That depends on how much bone is needed. According to Cambridge University Hospitals, a minor graft can be done in the same operation as the implant, while extensive grafting is done in its own operation at least four months before the implant.
For the waiting time after a separate graft, the sources give similar ranges:
- Guy’s and St Thomas’: in most cases the graft heals for three to six months before the implant is placed.
- Cambridge University Hospitals: block grafts heal for four to six months; it can take 4 to 12 months for the material to fuse completely with your own bone.
- Cleveland Clinic: the graft needs at least three months.
For your travel planning this means: a minor graft usually changes nothing about the usual two trips for implants. A large graft in its own operation can mean an additional trip, because months pass between the graft, the implant and the final teeth. Whether the bone is ready is judged at a check-up with an X-ray. More in our guide how many days in Türkiye for dental implants.
How does healing go, and what about the flight home?
According to Cambridge University Hospitals, swelling usually peaks on the second day, facial bruising is possible, and after the stitches come out, about 7 to 10 days later, most people feel better. Cleveland Clinic says that tenderness, swelling and bruising usually settle within one to two weeks. In the first days, small particles of the material can come out of the mouth; that is usually normal.
Cleveland Clinic’s advice for healing can be summarised like this:
- Do not touch the wound with your tongue or fingers
- Do not smoke, including e-cigarettes
- Do not spit or rinse forcefully
- No strenuous exercise in the first 48 hours
- Eat soft food and take prescribed medicines as agreed
There is little research on flying. A 2023 article in the British Dental Journal gives two weeks after more complex procedures such as a bone graft or sinus lift as the earliest point, provided there is no pain, swelling or bleeding, and offers this as a starting point for the dentist’s decision. When you can fly is therefore decided after surgery from how you heal; a flexible return ticket is sensible.
Cambridge University Hospitals says that minor problems such as infection, exposure of the material or failure of the graft occur in around 30 percent of cases, and that the risk is higher in smokers. If you have a fever, increasing swelling, pus or severe pain, do not wait for your check-up. If you are already home, a dentist near you is the first point of contact; also let us know on WhatsApp (see aftercare and follow-up).
How do we assess bone grafting at Rönesans?
At our clinic in Serdivan, the height and width of the bone are assessed three-dimensionally on a CBCT scan. We carry out bone grafting and sinus lifts at our clinic; treatment under general anaesthetic is possible if needed. For a preliminary assessment, send us photos and any existing X-rays on WhatsApp to +90 532 363 49 54; we reply in English and German.
Whether a graft is needed, whether it is done with the implant or in its own operation, and whether a temporary tooth is possible during healing is discussed with you after the examination and CBCT scan. This sets the number and length of your trips, which we plan around your travel dates. Before treatment starts you receive a written treatment and cost plan; the cost is confirmed after the examination. Transfer from Istanbul and accommodation in Sapanca are included in the treatment price. On departure you receive a copy of your treatment summary and your X-rays for your dentist at home. The implant procedure itself is described on our dental implants page.