Bone Augmentation Before an Implant: Why It’s Needed and What to Expect

Your dentist has told you that you need a “bone graft” – and you may be coming across the term for the first time. What does it mean, why can’t the implant be placed straight away, and what awaits you? We answer clearly and without needless worry.

Bone augmentation (the technical term for a bone graft) is a surgical procedure that restores the volume of the jawbone to the point where it can safely support a dental implant. Without a sufficient bone foundation, an implant would have no support and would be at risk of failure. This is not a dramatic operation, however – it is a standard, predictable procedure.

Why Bone Loss Occurs

The jawbone is maintained by the teeth loading it naturally every day – through chewing and biting. As soon as a tooth is missing, the bone in that spot is no longer needed and the body slowly begins to resorb it. This process cannot be prevented, but it can be slowed down – ideally with a timely implant.

After a tooth is extracted, the bone starts to shrink almost immediately. Research shows that during the first six months nearly a third of its width can disappear. The longer you wait for an implant, then, the less bone is left for it.

People with a removable denture tend to have a similar problem. A denture replaces the tooth in appearance, but it does not load the bone in the right way – so the bone continues to shrink. After ten years of wearing a denture, the jaw can become so reduced that the denture no longer fits properly.

Bone can also be lost in other ways – through gum disease, injury or unsuitable treatment in the past.

When Bone Augmentation Is Needed

This cannot be judged by eye, nor from an ordinary X-ray. The dentist needs a 3D scan of the jaw (CBCT), which shows precisely how much bone remains and what shape it has.

Put simply: a standard implant needs at least 8 mm of bone height and 6 mm of width. If these values are not met, the implant would have nothing to anchor to – and without augmentation the procedure would make no sense.

How much augmentation is needed depends on how much bone is missing. A smaller loss can be dealt with simply, while larger defects require a more complex approach.

For bone height, the minimum is 8 mm and the optimal value is 10–12 mm. For bone width, the minimum is 6 mm and the optimal value is 7–8 mm.

Augmentation Methods

There are several methods, and the dentist chooses the most suitable one according to where and how much bone is missing.

The most common method – guided bone regeneration (GBR) – works by the surgeon placing a bone substitute into the defect and covering it with a special membrane. This membrane acts as a barrier: it prevents soft tissue from growing into the site and gives the bone the space to regenerate undisturbed. This method has decades of clinical experience behind it and works well for small and medium-sized defects.

For larger defects, a block of the patient’s own bone is sometimes transferred – for example from the chin or the ramus of the jaw. The body accepts its own bone best; the disadvantage is that the surgeon works on two sites at once.

A sinus lift is a special variant for the back part of the upper teeth, where the maxillary sinus (an air-filled cavity within the skull) extends too low. The surgeon carefully raises it and fills the resulting space with bone material. There are two versions – a simpler one for smaller deficits and a more demanding one for larger losses.

Ridge splitting is used where the jaw is too narrow. The surgeon splits it lengthways and widens it, then fills the space with bone material.

Materials

The bone material can be autologous (taken directly from the patient), bovine (a xenograft – all organic components are removed from it, making it completely safe) or synthetic. Research shows that all types perform comparably well. In practice, bovine bone is used most often, sometimes in combination with the patient’s own bone.

Autologous bone comes from the patient’s own body; its advantage is the best integration and it serves as the reference standard, while its drawback is the second surgical site. A xenograft (Bio-Oss) is deproteinised bovine bone; it delivers excellent results and is widely used, with the trade-off of slower resorption. Alloplastic material is synthetic (hydroxyapatite, β-TCP); it needs no donor and is standardised, but vascularises more slowly.

The Course of Treatment

It depends on how large a bone defect needs to be filled. For smaller defects, the augmentation and the implant can be done together – in a single operation. You save both time and one surgical procedure.

For larger defects, the work proceeds in two steps: first the augmentation, then 4–6 months of waiting, a follow-up 3D scan and only then the implant. The bone needs time to heal and strengthen properly.

Which approach comes into consideration is decided by the dentist – not the patient. It is an experienced judgement based on 3D diagnostics and hundreds of similar cases.

Step by step:

1. Consultation + 3D CBCT diagnostics
2. Choice of method and material
3. Surgical procedure (local anaesthesia or conscious sedation)
4. Healing for 4–6 months
5. Follow-up CBCT
6. Implant placement (in the staged approach)
7. Prosthetic treatment after osseointegration

At Esthesion, the augmentation and the subsequent implant placement are carried out by the same surgeon – from the first consultation to the final prosthetics, everything takes place in one location. For patients who are anxious about a longer procedure, we offer conscious sedation managed by an anaesthetist: you are in a light half-sleep, you cooperate, but you experience the procedure without stress. Hospitalisation is not required.

Success Rate

Very high. Implants placed in augmented bone perform just as well as implants in natural bone – with a success rate of 90–96 % confirmed by numerous long-term studies. Bone augmentation is neither a problem nor a complication. It is a preparatory phase that creates the conditions for an implant to last for decades.

Frequently Asked Questions

Is augmentation painful?

The procedure is performed under local anaesthesia – you don’t feel the pain. Conscious sedation is available. Mild soreness and swelling last 3–5 days and are managed with ordinary painkillers.

Do I always have to wait 4–6 months?

Not always. For smaller defects, the augmentation and the implant can be done simultaneously. The dentist decides the approach on the basis of 3D diagnostics.

Is a xenograft (bovine bone) safe?

Yes. Deproteinised bovine bone (Bio-Oss) has been used in clinical practice for over 30 years. All organic components are removed during processing – only the mineral matrix remains.

Does insurance cover bone augmentation?

In most cases, no – augmentation is part of comprehensive implant treatment, which is not covered under the basic insurance plan. (In the Czech Republic, public health insurance does not cover this type of treatment.)

Conclusion

Bone augmentation extends the treatment by a few months. The result, however, is an implant on a solid foundation that will serve for decades. Modern methods and materials make this a predictable and manageable procedure – the key is the experience of the surgeon who performs it.

Not sure whether you have enough bone for an implant? Book a consultation – a 3D CBCT scan will give you a precise answer.