Bone Grafts
Why perform a bone graft?
A sufficient amount of bone is essential to place a dental implant and ensure its long-term stability.
When the bone is insufficient, we must rebuild the missing volumes in order to create a solid support for the implant.
In that case, we perform a bone graft. It can be done before implant placement (pre‑implant graft), or at the same time (peri‑implant graft), depending on your clinical situation.
What are the different types of bone reconstruction materials?
We use a wide range of materials and techniques for bone reconstruction.
The choice depends both on the surgical technique chosen and the patient’s preferences.
Autogenous bone (autograft)
We harvest bone directly from the patient, usually from the mandible.
This method requires a second surgical site, which lengthens the duration of the procedure.
Because two areas are operated on, postoperative recovery is often more pronounced. However, this type of graft generally offers the best biological properties, since the bone is perfectly compatible.
Allogeneic bone (allograft)
In this case, we use bone from another human. Generally, it is harvested from a donor’s femoral head, then processed and sterilized to eliminate any risk of contamination.
This method reduces its osteogenic properties, but it simplifies the procedure: it is shorter than an autograft and requires only one surgical site.
On the other hand, results may be less consistent depending on the case.
Bone biomaterials
Bone biomaterials represent an effective alternative to autologous bone grafts. Thanks to their use, the surgical intervention becomes shorter. However, the practitioner must adapt their technique to ensure good results.
Biomaterials may come from different sources. We distinguish two main categories:
- Xenogeneic biomaterials (animal origin)
These bone substitutes most often come from bovine tissues. Laboratories treat them to eliminate any risk of contamination.
Used for more than 20 years, these materials have been extensively studied in the scientific literature. Because of their demonstrated effectiveness, they allow faster interventions with reproducible outcomes. That is why they are now considered the reference material.
At 47VH, we favor high‑quality biomaterials from well‑known brands, validated in serious scientific publications.
- Synthetic biomaterials
Synthetic substitutes are chemically manufactured. However, their properties remain limited, and clinical results are often inconsistent. For this reason, we use them very rarely.
Growth factors
Growth factors are small proteins capable of accelerating biological processes — such as healing or bone formation.
However, their use is prohibited in Europe and in many countries. Even if some protocols or biomaterials claim to contain them, current scientific evidence is insufficient to validate their use in clinical practice.
Are there alternatives to bone grafts?
In certain cases, we use shorter or narrower dental implants to avoid a bone graft.
Recent technological advances have made it possible to design small implants with good mechanical properties. However, we do not recommend them in all clinical situations, as their indication depends on many factors.
Different techniques for bone reconstruction
In some cases, we must reconstruct bone in height, in thickness, or both, to allow for implant placement.
Today, we have many effective techniques to restore bone volumes. The choice of method depends mainly on the type, extent, and location of the bone defect.
Severe bone insufficiency
When bone loss is significant, we generally perform reconstruction before placing the implant. After this intervention, a healing period of 4 to 9 months is required before the implant can be placed in proper conditions.
Moderate bone insufficiency
If bone loss is moderate, we can perform the reconstruction and the implant placement in the same procedure. This simplifies the treatment and reduces its overall duration.
Preserving bone volume after extraction
To limit bone loss following tooth extraction, we offer immediate solutions. During an atraumatic extraction, we insert a biomaterial directly into the socket (the extraction site). Then, we protect it with collagen or a soft tissue graft.
This approach helps maintain bone volume from the outset. It facilitates subsequent implant placement and, in most cases, avoids more complex bone graft procedures later.
Clinical case
Extraction with alveolar preservation
Sinus floor elevation (sinus lift)
The sinuses are cavities located in the facial bone above premolars and molars.
After extraction of these teeth, the height of bone available beneath the maxillary sinus is often insufficient to place a dental implant. In that case, we perform a sinus floor elevation — also called sinus lift or sub‑sinus bone grafting — to recreate sufficient bone volume.
How does the procedure work?
We create a lateral bone access, then gently lift the sinus membrane. Next, we place a biomaterial to maintain the membrane in its new position. This step creates a space conducive to ossification.
It is then your own bone cells that gradually reconstruct the missing bone. In general, a sufficient amount of bone regenerates within about 4 months, allowing implant placement under favorable conditions.
What techniques are used for sinus lifts?
We primarily use two approaches, depending on the bone height available:
- Lateral approach (Tatum technique)
We favor this method when bone loss is substantial.
The surgical access is from the external side of the sinus. This technique is reliable and reproducible.
However, in most cases, implant placement is not done at the same time as the graft; it is done later, after consolidation.
- Axial approach (Summers technique)
We use this approach when bone resorption is moderate.
Access is via the crestal bone during implant drilling.
This technique is less invasive, fast, and causes minimal postoperative discomfort.Moreover, it generally allows implants to be placed in the same procedure as the graft.
We choose the technique best suited to your bone situation to ensure effective and durable reconstruction. The sinus lift thus makes it possible to place dental implants even in areas with significant posterior maxillary bone deficiency.
Clinical case
Lateral sinus lift
Guided bone regeneration (GBR)
Guided bone regeneration makes it possible to stimulate new bone formation by creating a space conducive to the natural regrowth of your own bone cells.
The surgeon applies a bone biomaterial, sometimes combined with autologous bone in the form of chips. A synthetic or collagen membrane is then used to stabilize the material, creating an environment favorable to regeneration.
These techniques have evolved significantly in recent years. Many variants are now available, and the choice depends on each patient’s specific needs.
Because they are more complex to carry out, these procedures require the intervention of an experienced surgeon. However, they allow the reconstruction of a large volume of high‑quality bone without the need for extensive donor site harvesting.
In some cases, we can place implants at the same time as the bone regeneration. This approach reduces the number of interventions and accelerates the overall treatment.
Clinical case
Simple horizontal guided bone regeneration
Clinical case
Advanced horizontal guided bone regeneration
Clinical case
Vertical guided bone regeneration
Bone grafting
Bone grafting allows adding additional bone volume where it is lacking by transplanting a bone fragment.
In the case of autografts, we harvest the bone directly from the patient, usually from another area of the jaw.
With allografts, we use a bone block from a donor, carefully prepared.
We adapt the bone fragment to the shape of the recipient site, then fix it securely with screws. Usually, after about four months, the grafted bone integrates into the jaw. Once this integration is complete, we can place the implant in the now‑sufficient bone volume.
We have used these techniques for many years with excellent results. Autogenous grafts offer very reliable bone quality and quantity, but require a second surgical site.
On the other hand, allogeneic grafts avoid this second intervention. However, the quality and volume of bone obtained may be less consistent.
Clinical case
Onlay autogenous graft
