Dental bone graft: when is it needed?
A dental bone graft is needed when there is not enough bone in the jaw to hold a dental implant. Patients sometimes call it a "gum bone graft", but the graft is placed in the jawbone under the gum; a graft of gum tissue is a different procedure, the gum graft. The procedure is tailored to each patient, according to the anatomy and the amount and location of missing bone. Dr Haim Aseriel follows patients through the whole process, from diagnosis and planning to surgery, healing and restoration.
At a consultation at the dental clinic in Jerusalem, held in English if you prefer, the options are explained in detail: an assessment is made, with 3D imaging (CBCT) at the clinic when needed, and you receive a detailed treatment plan with a written quote.
What is a dental bone graft?
Dental bone grafting is a surgical procedure that rebuilds or increases bone volume in the jaw when there has been bone resorption or significant bone loss.
A bone graft provides an essential base for future dental implants, creating a stable foundation for a successful, natural-looking restoration.
Bone material is added to the deficient area, where it integrates with the existing bone and forms a strong, stable base. The material can be the patient's own bone taken from another site, synthetic bone substitutes, or processed biological materials of human or animal origin.
PRF (platelet-rich fibrin), a concentrate prepared at the clinic from the patient's own blood that contains growth factors, is added when indicated. Studies found it may slightly increase new bone formation, but its effect on implant success has not been shown (Xie et al., Clinical Oral Investigations, 2025).
The procedure is done at the clinic under local anesthesia, and in more complex cases light oral sedation can be added to reduce anxiety and discomfort. Surgery is performed at the clinic together with Dr Yves Weinberg, head of the Oral and Maxillofacial Surgery Department at Barzilai Medical Center. Afterwards, a healing period of several months lets the bone material integrate before the implants are placed. When bone is missing, there are sometimes alternatives to a graft: short dental implants, zygomatic implants or basal implants, chosen after the examination and imaging.
What causes jawbone loss, and how is it diagnosed?
Jawbone loss can have many causes, the main one being tooth loss without a timely restoration.
When a tooth is extracted or lost, the bone in that area naturally resorbs: according to a systematic review, within six months the bone ridge loses about 29% to 63% of its width and 11% to 22% of its height, with most of the change in the first months (Tan et al., Clinical Oral Implants Research, 2012).
29-63%
of ridge width lost within six months of extraction
Other causes include advanced gum disease (periodontitis), long-standing dental infections, trauma, tumors, metabolic diseases affecting bone density, and long-term use of removable dentures, which press on the ridge and speed up resorption.
Diagnosis combines a clinical exam (gum condition, width and stability of the ridge) with imaging. 3D scans on the clinic's Planmeca ProMax 3D CBCT map the volume and density of the bone and the key anatomical structures, such as the maxillary sinus and the inferior alveolar nerve canal. The diagnosis also covers your medical history and medications, habits such as smoking, and systemic factors that may affect bone healing.
Who is a candidate for a dental bone graft?
A dental bone graft is for patients who need an implant-based restoration but have significant bone loss.
Suitable candidates
Patients who lost teeth long ago without a restoration, patients with advanced gum disease that caused bone loss, and patients after trauma or jaw surgery. The diagnosis determines whether a graft is really needed and which technique fits the clinical situation.
Precautions and contraindications
Uncontrolled diabetes, autoimmune diseases, head and neck radiation therapy, and certain medications such as bisphosphonates (for osteoporosis), because of the risk of medication-related osteonecrosis of the jaw (Ruggiero et al., Journal of Oral and Maxillofacial Surgery, 2022), all call for an in-depth assessment and adapted treatment.
Smokers are asked to cut down significantly or stop before the procedure and during healing, because smoking impairs bone healing.
Dental bone graft materials: where does the bone come from?
In oral and maxillofacial surgery, several sources of bone are used depending on each patient's clinical situation. The choice of graft material is an important part of success and directly affects integration and the future restoration.
| Graft material | Source |
|---|---|
| Autogenous | The patient's own bone |
| Allograft | Bone from a human donor |
| Xenograft | Bone of animal origin |
| Synthetic | Synthetic bone substitutes |
Autogenous bone is considered the "gold standard" because it provides living cells and growth factors as well as a structured bone matrix. Several materials are often combined, for example autogenous bone with a xenograft, to pair the healing potential of the patient's own bone with the long-term stability of the xenograft. According to a Cochrane systematic review, it is not clear that any technique or material works better than the others (Esposito et al., European Journal of Oral Implantology, 2009).
Dental bone grafting techniques
The technique is chosen according to the location, the amount of bone needed and the patient's general condition.
A sinus lift is an established technique for grafting bone in the upper back jaw: the sinus membrane is gently lifted and graft material is placed in the space created, so implants can be placed later.
Used when the bone is too narrow: special instruments split the existing ridge and graft material is placed in the gap, widening the ridge without a large graft. It is less invasive than block grafting.
For horizontal or vertical bone loss, special membranes are placed to keep soft tissue out of the graft site and allow new bone to form. PRF, a concentrate from the patient's own blood, is sometimes added to support healing.
In particularly challenging cases, blocks of bone are fixed to the ridge with tiny screws. After a few months of healing the implants are placed and, if they were covered by the gum, implant uncovering follows before the restoration. According to a Cochrane review, complications of bone augmentation, especially vertical, are common, and in the resorbed lower back jaw short implants appear to be a better alternative to vertical augmentation (Esposito et al., 2009).
Bone graft at the time of extraction (socket preservation)
The extraction socket can also be filled with graft material right after the tooth is removed, to limit bone loss before a future implant. According to a Cochrane review, socket preservation may reduce the loss of ridge width and height in the six months after extraction, but the evidence is very uncertain; no difference was found in the need for additional grafting before the implant, in implant failure, or between grafting materials (Atieh MA et al., Cochrane Database of Systematic Reviews, 2021).
The dental bone graft procedure
Local anesthesia
The surgery starts with local anesthesia of the area. In complex cases, or for anxious patients for whom other measures are not enough, light oral sedation (a prescribed pill) can be added.
Preparing the graft site
A gentle incision in the gum creates a flap that gives access to the bone. Following the 3D-based plan, the site is prepared (removing granulation tissue or areas of inflammation, smoothing uneven surfaces) before the graft material is placed.
Membranes and stitches
Depending on the technique, a membrane may cover the graft to hold it in place and keep soft tissue out; titanium mesh or pins are sometimes used for stability. The flap is then closed with stitches.
The surgery lasts from about 30 minutes to two hours, depending on complexity. Afterwards you receive detailed recovery instructions; medicines such as pain relievers, and antibiotics when the doctor decides they are needed, are given by prescription only. Healing is monitored at a series of scheduled visits.
Examination, treatment plan and price quote
detailed and personalized
During the consultation, Dr Haim Aseriel examines your teeth, explains all the options and gives you a transparent price quote, with no obligation. The clinic is at 12 HaTnufa Street, Jerusalem.
Before and after dental bone graft surgery
1. Before the surgery
A full assessment, with a clinical exam, X-rays and 3D imaging, allows precise planning and the choice of the most suitable material. Tell the team about any medical condition, regular medications and known allergies. Smokers are strongly advised to stop before surgery and during healing, as the doctor instructs. Do not stop or change regular medications, especially blood thinners, without speaking to the prescribing doctor. If light oral sedation is planned, follow the fasting instructions, come with a companion and do not drive afterwards.
2. After the surgery
Rest for 24 to 48 hours and avoid significant physical effort for about a week. Take any prescribed medicines exactly as directed, even if the pain eases. To reduce swelling, apply wrapped ice to the outside of the cheek, 10 to 20 minutes at a time, in the first hours. For the first days, eat soft, cool foods, avoid hot, spicy or hard foods, and do not rinse vigorously. Gentle rinses, for example with an antiseptic solution, start only when the dentist says so. Avoid touching the area, including with your tongue or toothbrush, until told otherwise.
Dental bone graft recovery
01
The first days
Some swelling and discomfort are expected as part of healing.
02
The first week
Keep following the post-surgery instructions. A balanced diet rich in protein, vitamins and minerals supports bone building and healing.
03
After about two weeks
Swelling and pain should have eased considerably. Connective tissue starts to grow into the graft and new blood vessels form (vascularization), supplying the developing bone.
Full healing and integration of the new bone take several months, depending on the graft material and the size of the area. During this time the bone remodels: the graft material is gradually replaced by the patient's own new bone, creating a stable base for future implants.
Dental bone graft side effects
Like any surgery, a dental bone graft can come with side effects that are worth knowing and managing. The most common are swelling, pain and discomfort in the first days. Bruising on the cheek and neck may appear after a day or two and fades gradually within about a week. These are normal and usually not a sign of a complication.
- Infection: a significant complication, shown by severe pain that does not respond to pain relievers, increasing swelling, high fever or pus from the area.
- Graft failure: rarely, persistent inflammation or graft particles coming out through the gum.
- Nerve injury: rarer; numbness or tingling of the lip, chin or tongue, usually temporary over weeks or months, rarely permanent. Imaging maps the nerves beforehand to minimize this risk.
Follow-up visits, and gum treatment when needed, help detect and treat these complications early. Fever, swelling spreading toward the eye or the neck, or difficulty swallowing or breathing require going to the emergency room immediately.
After the assessment, the written quote lists each stage, and itemized receipts can be submitted to your insurer (reimbursement depends on your policy; see dental implant cost). Dr Haim Aseriel (DDS, NYU College of Dentistry) sees patients at 12 HaTnufa Street in Talpiot, south Jerusalem, open Sun 8:00–19:00 · Mon 9:00–19:00 · Tue–Wed 9:00–21:00 · Thu 8:30–21:00 · Fri 8:00–14:00. You can also read patient reviews.
Dental bone graft: frequently asked questions
A dental bone graft is done under local anesthesia, so there should be no pain during the surgery; anxious patients can add light oral sedation by prescription. Pain, swelling and discomfort are common in the first days after surgery and ease gradually. The pain reliever and the dose are decided with your dentist or pharmacist.
Bone loss in the mouth is mainly caused by tooth loss: after an extraction the bone resorbs, and according to a systematic review the width of the bone ridge shrinks by about 29% to 63% within six months. Other causes include advanced gum disease, infections, trauma, cysts and long-term use of removable dentures.
Sometimes: when there is enough bone to stabilize the implant, it can be placed in the same surgery with bone added around it. When the bone loss is large, for example with block grafting, the new bone is left to integrate for several months before the implants are placed. The decision is based on the examination and the CBCT scan.
After a dental bone graft, swelling and pain usually ease considerably within about two weeks. The new bone takes several months to integrate with the existing bone, depending on the graft material and the size of the area, and only then are the implants placed, if they were not placed during the graft surgery.
Common side effects of a dental bone graft are swelling, pain and discomfort in the first days, and sometimes bruising on the cheek and neck that fades within about a week. Severe or increasing pain, fever, pus or graft particles coming out through the gum require contacting the clinic. Complications, especially with vertical bone augmentation, are not rare.
Sources
- Tan WL et al., Clinical Oral Implants Research, 2012 – Link to study
- Esposito M et al., European Journal of Oral Implantology (Cochrane systematic review), 2009 – Link to study
- Xie S et al., Clinical Oral Investigations, 2025 – Link to study
- Ruggiero SL et al. (AAOMS), Journal of Oral and Maxillofacial Surgery, 2022 – Link to study
- Atieh MA et al., Cochrane Database of Systematic Reviews, 2021 – Link to study
