Bone Grafting

Bone Grafting

This information explains bone grafting procedures, which may be necessary before dental implant placement.

Why is bone grafting needed?

Bone loss in the jaw can occur for several reasons, including:

  • Tooth extraction: When a tooth is lost, the supporting bone no longer receives stimulation and begins to resorb (shrink).

  • Gum disease: Periodontal disease can damage the bone supporting your teeth.

  • Trauma: Injuries to the jaw can result in bone loss.

  • Long-term denture wear: Dentures can put pressure on the underlying bone, leading to resorption over time.

  • Congenital defects: Some individuals may have naturally deficient bone in certain areas of the jaw.

  • Sinus Pneumatisation: In the upper jaw (maxilla), the sinuses can expand or “pneumatise” after tooth loss, encroaching on the bone where implants would be placed.

Adequate bone volume and density are essential for successful dental implant placement. If you have experienced bone loss, a bone graft can rebuild the deficient area, providing a stable foundation for your implants. In cases of sinus pneumatisation, a procedure called a sinus lift can be performed. This gently lifts the sinus membrane, creating space for bone grafting material and restoring the necessary bone height for implant placement.

Types of Bone Grafts:

Several types of bone graft materials are available, and your surgeon will recommend the most suitable option for your individual needs. These include:

  • Autografts: Bone taken from another part of your own body, such as the tibia (shin bone) or hip bone. While highly effective, this involves a second surgical site.

  • Allografts, Xenografts, and Alloplasts: These are off-the-shelf medical products derived from donor bone (allografts), animal bone (xenografts), or synthetic materials (alloplasts). Importantly, for many smaller bone grafting procedures, these products mean we can avoid the need for a second surgical site, leading to a quicker recovery and reduced discomfort. This is a common and effective approach in modern surgical implant procedures.

This information is intended to provide a general overview. Your surgeon will discuss your specific situation and treatment plan in detail.

What to expect with Bone Grafting

This information will guide you through the bone grafting process, a vital step towards achieving a stable and beautiful smile with dental implants.

During the Procedure:

The modern standard of care for bone grafting procedures is to perform them under general anaesthetic. This means you will be fully asleep and unaware of the procedure, ensuring a comfortable and stress-free experience. General anaesthesia also contributes to a quicker recovery.

Your surgeon will begin by making a small incision in your gum tissue to expose the underlying bone. Depending on the type of graft being used, the following steps will be taken:

  • For off-the-shelf grafts (allografts, xenografts, alloplasts): The grafting material will be carefully placed and shaped to rebuild the deficient bone area.

  • For autografts (bone taken from your own body): If a larger graft is required, and bone is taken from another site (such as the hip or tibia), a separate incision will be made in that area. The bone will then be harvested and shaped before being placed in your jaw.

  • For sinus lifts: If the bone loss is due to sinus pneumatisation, a small opening will be made in the side of the sinus cavity. The sinus membrane will be gently lifted, and the grafting material will be placed beneath it.

Once the graft is in place, the gum tissue will be sutured closed.

After the Procedure:

  • Following the general anaesthetic, you will be monitored in a recovery area until you are fully awake.

  • You may experience some swelling, bruising, and discomfort in the surgical area. This can be managed with prescribed pain medication.

  • You will be given specific post-operative instructions, which may include dietary restrictions, oral hygiene guidelines, and follow-up appointments.

  • It is important to avoid strenuous activity for a few days after the procedure.

  • Depending on the size of the graft, and the location, healing can take several months. During this period the graft fuses with your existing bone, creating a strong foundation for dental implants.

  • If a second surgical site was used to harvest bone, you will also have post operative care for that area.

  • Modern bone grafting with general anaesthetic promotes a more comfortable and faster recovery than previous methods.

Sinus Precautions (if a sinus lift was performed):

If you underwent a sinus lift, it is essential to follow these additional precautions to ensure proper healing:

  • Avoid blowing your nose: This can create pressure in the sinus cavity and dislodge the graft. If you need to sneeze, do so with your mouth open.

  • Avoid using straws: Sucking can also create pressure in the sinus area.

  • Use prescribed nasal sprays or decongestants as directed: These can help keep your sinuses clear.

  • Avoid air travel for a specified period: Your surgeon will advise you on the appropriate timeframe.

  • Avoid smoking: Smoking impedes healing.

  • Take care when coughing: try to cough with your mouth open to reduce sinus pressure.

Follow-up:

Regular follow-up appointments with your surgeon are crucial to monitor healing and ensure the success of the bone graft. Your surgeon will determine when you are ready for surgical implant placement.

This information is intended to provide a general overview. Your surgeon will discuss your specific post operative care and healing expectations in detail.

Risks

Bone grafting and sinus lift procedures are generally very safe, especially when performed by a specialist oral and maxillofacial surgeon under general anaesthetic. This approach ensures patient comfort and minimises risks. However, as with any surgical procedure, it's important to be aware of the potential risks and complications.

General Risks Associated with Bone Grafting and Sinus Lifts:

  • Infection: As with any surgical procedure, there is a risk of infection at the graft site.

  • Bleeding: Some bleeding is normal after surgery, but excessive bleeding can occur.

  • Swelling and Bruising: These are common side effects and usually subside within a few days.

  • Graft Failure: In rare cases, the graft may not integrate properly with the existing bone.

  • Sinus Complications (Sinus Lift Specific):

    • Sinus membrane perforation: A tear in the delicate sinus membrane can occur during the procedure.

    • Sinusitis: Inflammation or infection of the sinuses.

    • Blockage of the sinus drainage pathway.

  • Numbness or Tingling: Temporary or, in rare cases, permanent numbness or tingling can occur in the area surrounding the surgical site.

Risks Associated with Autologous Bone Grafts (Bone Taken From Your Own Body):

When bone is harvested from another part of your body, there are additional risks associated with the donor site:

  • Pain and Discomfort: Pain and discomfort at the donor site are common.

  • Infection: Infection can occur at the donor site.

  • Scarring: Scarring will occur at both the graft site and the donor site.

  • Nerve Injury (Mandible Donor Site):

    • Inferior Alveolar Nerve Injury: If bone is taken from the mandible (lower jaw), there is a risk of injury to the inferior alveolar nerve, which can cause numbness or tingling in the lower lip, chin, and teeth.

    • Lingual Nerve Injury: Injury to the lingual nerve can cause numbness or tingling on the tongue.

  • Mandibular Fracture (Mandible Donor Site): Taking bone from the mandible can weaken the jaw, increasing the risk of fracture.

  • Hip or Tibia Donor Site Risks: Pain, infection, and in very rare cases, fracture can occur at these sites. In addition, there may be an area of numbness that develops around the area.

Minimising Risks:

Your surgeon will take every precaution to minimise these risks, including:

  • Thorough pre-operative assessment and planning.

  • Using sterile surgical techniques.

  • Prescribing antibiotics and pain medication.

  • Providing detailed post-operative instructions.

When to Seek Immediate Medical Attention:

Contact your surgeon immediately if you experience:

  • Excessive bleeding.

  • Severe pain that is not relieved by medication.

  • Signs of infection, such as fever, redness, or swelling.

  • Numbness or tingling that worsens or persists.

  • Any other concerns.

This information is intended to provide a general overview. Your surgeon will discuss your specific risks and benefits in detail before the procedure.

Fees

This information outlines the typical fees associated with bone grafting and sinus lift procedures. It's important to understand that the fees can vary depending on the complexity of the procedure and where it is performed.

  • In-Clinic Procedures: Sometimes, simple bone grafting procedures can be performed in the clinic under local anaesthetic, similar to a dental procedure. In these cases, there will be no anaesthetic fee or hospital fee. Your surgeon will discuss if this is an option for you.

  • Hospital Procedures: More complex procedures, including sinus lifts and larger bone grafts, are typically performed in a hospital or surgical facility under general anaesthetic. These procedures generally involve three separate fees:

    • Surgical Procedure Fee: This covers the surgeon's time and expertise in performing the bone grafting or sinus lift.

    • Anaesthetic Fee: This covers the fees for a specialist anaesthetist who will safely administer the general anaesthetic, ensuring you remain asleep and comfortable throughout the entire procedure.

    • Hospital Fee: This covers the cost of using the hospital or surgical facility, including operating theatre time, nursing care, and supplies.

Medicare and Private Health Insurance Coverage:

Bone grafting procedures are considered medical procedures and are therefore eligible for partial coverage through Medicare and your private health insurance (hospital cover).

  • Medicare: Medicare will provide a rebate based on the Medicare Benefits Schedule (MBS) codes listed below.

  • Private Health Insurance (Hospital Cover): Your private health insurance (hospital cover) will also contribute towards the hospital and surgical fees, depending on your specific policy.

  • "Extras" Cover: Please note that "extras" or ancillary cover typically does not apply to bone grafting or sinus lift procedures.

Medicare Benefits Schedule (MBS) Codes:

The following MBS codes are used for billing these procedures:

  • Ridge augmentation/Bone grafting (per side): 45841

  • Harvesting a graft from elsewhere and grafting to the area that is required: 48248

  • Maxillary sinus augmentation (per side): 45849

Important Considerations:

  • The exact amount of the Medicare rebate and private health insurance coverage will vary depending on your individual circumstances and policy.

  • You will likely have out-of-pocket expenses for these procedures.

  • It is essential to contact your private health insurance provider and Medicare to confirm your specific coverage and potential out-of-pocket costs before undergoing the procedure.

  • Your surgeon's office will provide you with a detailed breakdown of the fees and assist you with understanding the billing process.

  • Be sure to discuss all fees with your Surgeon's rooms before proceeding with any treatment.

This information is intended to provide a general overview. Please consult with your surgeon's office, Medicare, and your private health insurance provider for personalised information regarding your fees and coverage.