Jawbone Augmentation as the Foundation for Stable Implants

A jawbone augmentation (also known medically as augmentation) refers to surgical procedures designed to restore lost bone mass in the jaw.

But why is a bone graft necessary in the first place? After tooth loss, the jawbone resorbs because it no longer receives the natural stress provided by the tooth roots. Without sufficient bone mass, dental implants or other forms of prosthetic restoration cannot be securely integrated.

A bone graft is necessary when the volume or quality of the bone is insufficient to ensure the long-term stability of an implant.

Jawbone augmentation is usually performed when a patient requires dental implant placement. This is typically the case when the existing bone mass is insufficient to ensure a secure fit for the implant. 

After an implant is placed, the jawbone is supposed to fuse with it. Medical professionals refer to this as osseointegration. If the jawbone is damaged, this cannot occur. 

Jawbone augmentation may also be necessary when a denture or other type of dental prosthesis is planned. Furthermore, jawbone augmentation is used in the field of periodontology.

In cases of advanced periodontitis, the tooth becomes loose and the jawbone is damaged. To strengthen the periodontal ligament, a jawbone augmentation may then be necessary. 

In this case, a specific bone preservation procedure is used: Guided Bone Regeneration (GBR). This procedure uses a special membrane to stimulate targeted bone regeneration.

Inflammatory processes in the dental socket, age-related bone resorption, and significant bone loss following extractions can all be reasons for such a procedure.

Aesthetics also play a role. A sunken row of teeth or visible defects in the upper jaw can be functionally and aesthetically impairing.

Bone grafting is necessary when there is insufficient bone mass to place a dental implant @ bilderzwerg /AdobeStock

A thorough diagnostic evaluation is performed before the procedure. In addition to a clinical examination, modern X-ray equipment is used. The DVT (digital volume tomography) provides particularly precise results, enabling three-dimensional (3D) images of the anatomical structures.

This allows structures such as the maxillary sinus, the sinus floor, or the course of sensitive nerves to be visualized with millimeter precision. This is particularly crucial before a sinus lift.

The augmentation can be performed in various ways. First, experts distinguish based on the material used. 

In most cases, dentists use the patient’s own bone, harvested from the patient’s chin, jaw, or iliac crest. In this procedure, bone is surgically harvested from the iliac crest and transplanted into the jaw.

Natural bone substitute materials are used as an adjunct to this autologous bone or for smaller jaw defects. They are usually derived from animal bones. Synthetic bone substitute materials, on the other hand, use an industrially manufactured material. There are also combined bone substitute materials containing biological growth factors.

Alternatively, bone augmentation can be performed using particulate bone material. This is placed into the defect and covered with a membrane. Autologous blood is often added to promote healing.

The procedure varies depending on which method is used:

• If bone is taken from the iliac crest, an iliac crest graft is performed. For this procedure, the patient must stay in the hospital for a few days. During the procedure, the dentist removes several bone blocks from the pelvis and places them directly into the jaw. If a large amount of bone material is needed, this method is the appropriate choice. 
• If bone is taken from the chin or the upper or lower jaw, the procedure is performed at the dentist’s office. 
• If animal or synthetic bone material is used, the treatment is also performed at the dentist’s office. The dentist inserts this material into the jaw in the form of granules.

In addition to the material used, medical professionals distinguish between other surgical methods.

The most common variant is the sinus lift. This is a minimally invasive procedure performed in the oral and maxillary cavities. During the procedure, doctors elevate the sinus floor—that is, the partition between the oral and maxillary cavities. A distinction is made between an internal sinus lift (minimally invasive) and an external sinus lift (for more severe bone loss).

The alveolar ridge is thus raised from the inside of the oral cavity to create space for additional bone. A sinus lift is well-suited for patients who have lost bone mass due to periodontitis or who have lost several molars. 

There may also be a genetic predisposition to bone loss, or the bone quality may not be sufficient for an implant. In this case as well, a sinus lift can be performed.

Before the sinus lift, the dentist will take a detailed medical history of the patient. An X-ray of the teeth will also be taken. Local anesthesia is sufficient for the procedure itself.

This means the patient can eat and drink as usual before the procedure. The dentist then lifts the gum tissue at the site where the bone loss is to be corrected. 

The dentist then fills the area with bone substitute material, along with some of the patient’s own blood. A membrane is placed over the wound, and the dentist then sutures the gum closed.

Healing takes some time. Depending on the patient, it takes between three and nine months. Only then does the dentist place the implant.

Those who do not want to wait that long should opt for bone augmentation during the implantation procedure. Drilling produces tiny bone chips, which the dentist collects and uses to reinforce the bone.

A sinus lift is a surgical technique used to create space for a dental implant in the upper jaw @ Pepermpron /AdobeStock

A sinus lift is not performed by a general dentist, but rather by an experienced oral surgeon, implantologist, or specialist in oral and maxillofacial surgery. These professionals possess the necessary surgical expertise.

Depending on the complexity of the procedure, the costs for a bone graft can vary significantly. Statutory health insurance usually does not cover these costs in full. An individualized cost estimate should therefore be obtained in advance.

However, some supplemental dental insurance plans cover a large portion of the costs. Depending on the complexity and difficulty of the procedure, an iliac crest graft can cost up to 6,000 euros. The cost of a sinus lift is significantly lower, averaging 600 euros.

In some patients, a jawbone augmentation cannot be performed. 

This applies, for example, to people with:

• Acute sinusitis
• Dental cysts, or 
• hemophilia (blood clotting disorders)
• Severe systemic disease

Jawbone augmentation is also not recommended for patients with diabetes or various respiratory diseases.

In such cases, patients should opt for implants that do not require bone grafting. Patients may also choose removable dentures as an alternative.

It takes about ten days for the gums to heal completely after the procedure. Healing can be accelerated with adequate cooling.

Driving is not recommended immediately after the procedure. In addition, patients should avoid alcohol and cigarettes if possible.

Thorough oral hygiene is important, but you should avoid the treated area. In the first few days after surgery, you should avoid physical exertion as well as visits to the sauna and tanning bed.

Bone grafting is considered a low-risk routine procedure. Nevertheless, potential complications may occur, such as

• Postoperative bleeding
• Hematomas
• Infections
• Temporary sensitivity

Overall, the chances of success are very good. The newly formed bone enables a long-term, stable restoration with dental implants.

How long does the healing process take after a sinus lift?

After a sinus lift, the healing period usually lasts 3–9 months.

Is a bone graft painful?

The procedure is performed under adequate anesthesia, and postoperative discomfort is usually mild.

How much does it cost?

The cost of a jawbone graft varies greatly depending on the method and extent of the procedure.

When is a jawbone graft necessary?

If there isn’t enough bone available for an implant, a bone graft is necessary.

Is it possible to place implants without a bone graft?

In some cases, implants can be placed directly, provided there is sufficient remaining bone.