Plate 04 · Procedures
Bone & soft-tissue grafting
Grafting is the unglamorous half of implant surgery and it decides most outcomes. The material matters less than the blood supply, the tension-free closure and the stability of the graft — which is why we spend consent time on flap design rather than on brand names.
For the referring practice
Ridge preservation, guided bone regeneration, lateral-window and transcrestal sinus augmentation, and keratinised-tissue grafting around teeth and implants.
In plain language
Rebuilding bone or gum where there is not enough of either — usually so an implant can be placed later, and usually months before it.
Both are always on this page. The switch in the header decides the order everything else is presented in, not whether you are allowed to read it.
01
When we would operate
And, just as importantly, when we would not. A referral that ends in a recommendation to do nothing is a good outcome, not a wasted appointment.
- Ridge preservation at the time of extraction where implant placement is planned
- Horizontal or vertical deficiency that would leave threads exposed
- Residual bone height in the posterior maxilla insufficient for planned fixture length
- Dehiscence or fenestration anticipated from CBCT
- Inadequate keratinised mucosa around a planned or existing implant
- Shallow vestibule limiting hygiene access
02
How it is done
Choice of graft material — honestly
Autogenous bone is the only material that brings living cells; it is the reference standard and it costs a donor site. Allograft is osteoconductive and osteoinductive without a donor site. Xenograft is osteoconductive and resorbs very slowly, which is useful for volume maintenance and unhelpful where you want turnover. Alloplasts are osteoconductive scaffolds. Most of our cases use a composite, and we will tell you exactly what went in.
Guided bone regeneration
A resorbable collagen membrane for contained defects; a non-resorbable or titanium-reinforced membrane where space must be maintained against soft-tissue collapse. Tension-free primary closure is non-negotiable — a dehisced membrane usually means a lost graft.
Lateral-window sinus augmentation
For residual bone height below roughly 5 mm, or where a wide lateral approach is needed. Piezoelectric osteotomy of the window, careful elevation of the Schneiderian membrane, graft placement, and a barrier over the window.
Transcrestal (Summers) approach
Where residual height is around 5–8 mm and only a few millimetres of lift are needed, often with simultaneous placement. Lower morbidity, less visibility of the membrane, and a lower ceiling on how much can be achieved.
Soft-tissue grafting
Free gingival graft to increase keratinised width; subepithelial connective tissue graft for root or implant coverage and thickness. Palatal donor site, or a dermal allograft where the patient declines a second site.
| Term | What it records |
|---|---|
| Autogenous | Osteogenic · osteoinductive · osteoconductive — needs a donor site |
| Allograft (FDBA/DFDBA) | Osteoinductive · osteoconductive — human donor, processed |
| Xenograft | Osteoconductive — very slow resorption, good volume maintenance |
| Alloplast | Osteoconductive scaffold — synthetic, predictable handling |
| Resorbable membrane | Contained defects · 4–6 month barrier function |
| Non-resorbable / Ti-reinforced | Space maintenance · needs a second procedure to remove |
- CBCT — we need to see residual height, sinus septa and the position of the posterior superior alveolar artery in the lateral wall.
- A note on sinus history: chronic sinusitis, prior FESS, nasal obstruction, allergy.
- For soft-tissue cases, photographs and a probing chart are more useful than a radiograph.
A note back to you
For ridge preservation, the referral is more useful before the extraction than after it. If you are extracting and want the site preserved for later implant placement, send us the case in advance and we will either graft at the time of your extraction or schedule the extraction with us.
04 · Consent
Risks, stated rather than softened.
Every figure below is a published-literature range and is labelled as one. None of them is a claim about this practice's results, and there are no success rates anywhere on this site. You should hear all of this out loud before you consent to anything, not only read it.
Schneiderian membrane perforation
The commonest intraoperative event in lateral-window sinus lifts. Small perforations are repaired with a collagen membrane and the graft proceeds. Large ones mean abandoning the graft that day and returning in a few months.
Literature: lateral-window perforation frequently reported around 10–20%
Sinusitis
Post-operative maxillary sinusitis, more likely where there was pre-existing sinus disease or where a perforation occurred. Usually settles with antibiotics and decongestants; occasionally needs ENT input.
Graft infection or failure
Partial or complete loss of the graft, usually announced by dehiscence and discharge in the first fortnight. It generally means removing the graft and starting again later.
Wound dehiscence
Exposure of the membrane or graft. Smokers are at materially higher risk, and we will ask you to stop before and after — not as a moral position, as a mechanical one.
Donor-site morbidity
A palatal donor site is the sorest part of a connective tissue graft for most patients, for one to two weeks. Chin or ramus block harvest carries its own risks of altered sensation.
MRONJ
Grafting in a patient on antiresorptive or antiangiogenic medication carries osteonecrosis risk and requires a documented risk discussion and, often, a conversation with the prescriber.
Under-correction
Grafts remodel and some volume is always lost. Vertical augmentation is substantially less predictable than horizontal, and we will say when we think a shorter implant or a different plan is the better answer than a bigger graft.
05
What the timeline looks like
Recovery varies between people. The general recovery instructions — bleeding, swelling, diet, medication timing and dry socket — are on the after-your-surgery page.
06 · For patients
The questions people actually ask us in the chair.
Why can I not just have the implant now?
Because an implant needs bone around all of it. If we place one into a site that is too narrow or too short, threads sit exposed and the implant is compromised from day one. Grafting buys the foundation. It adds months, and it is worth them.
Sinus precautions, plainly
For two weeks after a sinus graft: do not blow your nose, sneeze with your mouth open, no straws, no smoking, no flying if you can avoid it, and no lifting anything heavy. Pressure in your nose is pressure on the graft.
Where does the bone come from?
Usually from a processed human or bovine source, or a synthetic mineral — all sterile and regulated. Sometimes from your own jaw. We will tell you exactly which before you consent, and we are happy to discuss it if the source matters to you for religious or personal reasons.
07
More on this procedure
Next
Send us this case with the imaging listed above, or call the referral line on (612) 555-0150 if it needs to be seen sooner than a form allows.
If your dentist has already referred you, we will contact you to book. If you would like a second opinion, you can come to us directly.