In this answer
What bone grafting does
Less than most people think. It's mostly a placeholder.
Graft material doesn't make bone grow. It holds a space open so your own bone can grow into it, a bit like saving a seat.
That matters because gum grows many times faster than bone, roughly a quarter to half a millimeter a day. Take a tooth out and leave the hole empty, and gum fills it long before bone can. Graft material, sometimes with a thin collagen layer over it, stops that happening.
What happens to an empty socket
Bone lost in 6 months, socket left empty
That was 29 to 63% of the width by 6 to 7 months, and 11 to 22% of the height by 6 months.
Bone saved by filling the socket
Left empty, a socket loses more width than height. Filling it with graft material saved about 2 mm of width and 1.7 mm of height, compared with letting it heal on its own. That is the place-holding job this page describes.
Left: a review of 20 studies of sockets left to heal on their own. Right: 22 trials that sorted people into groups at random, with 3 to 6 months of healing and several graft materials. Neither review is about full-arch treatment. It shows a graft holds space. It does not show that everyone needs one.
- Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res. 2012;23 Suppl 5:1-21. doi:10.1111/j.1600-0501.2011.02375.x. PMID 22211303.
- Avila-Ortiz G, Chambrone L, Vignoletti F. Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis. J Clin Periodontol. 2019;46 Suppl 21:195-223. doi:10.1111/jcpe.13057. PMID 30623987.
The paper cup
Picture a paper cup. A whole one holds water. Cut a strip out of one side and it only holds water up to the cut. Cut two sides and it barely holds anything.
A tooth socket is like that. Some come out clean and keep their shape. Some have a broken wall. The more of the cup that's missing, the more material we add and the sturdier it needs to be.
That's why the answer is different for everyone.
Not all graft material is the same
Graft materials differ in how well they hold a space and how readily they turn into your own bone, and you usually trade one for the other.
At one end is a demineralized material that's little more than a collagen scaffold. It holds almost no space and collapses under pressure, so it's mainly used to carry something else in a socket that's already intact.
At the other end is bovine (cow-derived) material. It's very dense, holds space well, and stays as it is for a very long time. On an X-ray it looks like bone, but it doesn't always behave like bone, and you can't easily tell until there's a problem. It has its uses, sinus work among them, but we wouldn't want a whole implant surrounded by it.
We use something in the middle: processed human donor bone, about 70% from the dense outer layer and 30% from the softer inner part. It has enough structure to hold a space, and it turns into your own bone, usually within about six months.
Where ours comes from
Tissue banks aren't all alike, and this is one place in dentistry where the source matters.
Dr. Noorthoek chose our supplier after visiting its processing facility during residency. He walked the building, met the staff, and saw how they keep records and handle tissue. It wasn't chosen on price, and it isn't the cheapest.
The same facility handles tissue for organ and large-bone transplants, and dental work is a small part of what it does. Seeing that level of care first-hand is why we've never looked elsewhere.
Start with a free conversation.
Why you may have been quoted so much
Often the other practice is planning single implants. Each one has to go exactly where the tooth was, and if there isn't enough bone in that spot, bone has to be built there. That's a real need.
A full arch works differently. Four to six implants carry the whole arch, and we can angle and move them to find bone that's already good. We start by looking for good bone, not for places to add it.
Sometimes it's inexperience. If you can't predict how much you can work around, grafting everywhere feels like the safe move, and the quotes get very large.
Grafting also has its own billing code, so in a fee built from line items it's an easy thing to add. We don't charge for it separately, so that never comes into it here.
His demeanor, knowledge and honesty sincerely helped me make the right decision, hence the reason I just had to write this review.
The full-arch advantage
Once the implants are in and your new teeth are screwed on, that bridge covers the whole site like an umbrella. It does part of the space-holding job a graft would otherwise do alone.
It's one more reason full-arch cases need less grafting.
What to ask
If you've been quoted a lot of grafting, these three questions help.
Is this for single implants or a full arch? They're different problems with different answers.
Which spots need it, and why those? Someone who has planned it can point to the place and tell you what's wrong there.
Is it billed separately? Separate billing isn't wrong. It's just good to know whether the advice and the bill are connected.
Quick answers
Why did another practice quote me thousands in grafting?
Often they were planning single implants, where each one has to go exactly where the tooth was. Sometimes it's because they're less sure how much can be worked around in a full-arch case.
Do you charge extra for bone grafting?
No. Whether we use graft material or none at all, your fee stays the same.
Does bone grafting mean waiting months?
Sometimes, if an area needs to grow bone before an implant can go in. That's much less common in full-arch work than with single teeth.
Where does the graft material come from?
Processed human donor bone from a tissue bank, which is standard in this field. We chose ours after visiting the facility in person.
Hear it on the podcast
Read next
My dentist said I need a sinus lift. Do I really need one for full-arch implants?
Almost certainly not. In our own records, fewer than 1% of full-arch patients have needed a sinus lift. In a full-arch case we angle the implants so they avoid the sinus altogether. If you were told you need one, that advice was most likely for a single implant, which is a different procedure with different needs.
Answered by Dr. Daniel R. Noorthoek
Read the full answerAll-on-4 vs All-on-6: how many implants do I actually need?
Four per arch, in most cases. More implants aren't better. Extra implants sit closer together, reach further back into bone that handles chewing poorly, and each one adds another screw hole through your teeth, which makes them weaker. Adding implants doesn't add teeth, either. We look at your scan before we settle on a number.
Answered by Dr. Daniel R. Noorthoek
Read the full answerWill I be put to sleep? What kind of sedation do you use?
Oral sedation only; we do not offer IV sedation or general anesthesia. You won't be unconscious. You'll be deeply relaxed, mostly unaware of time passing, and able to open your mouth when asked. If being completely under is essential to you, we're not the right practice, and we'd rather tell you that before you book.
Answered by Dr. Daniel R. Noorthoek
Read the full answer