Bone Graft

What is a bone graft?

A bone graft is a procedure that adds bone, or a bone-like material, to an area where you've lost bone or where a fracture hasn't healed properly. It gives your body a scaffold to grow new bone onto, helping to repair, strengthen, or rebuild the area.

What conditions does it treat?

A bone graft may be used to:

• help a complex fracture heal, or treat a fracture that hasn't healed properly on its own
• replace bone lost to injury, infection, or a tumour
• build up your jawbone before, or at the same time as, dental implants
• fill the socket left after a tooth is removed, or rebuild your jaw before dentures
• treat bone loss caused by gum disease
• support spinal fusion surgery
• replace bone lost around a joint replacement that needs revision surgery.

What are the benefits of having a bone graft?

A bone graft gives you a stronger foundation for dental implants and other restorative treatments, and can restore your jaw or bone to close to its original shape and function after trauma, tooth loss, or gum disease. Success rates are high, up to 100% depending on the type of graft used, and using your own bone carries the lowest risk of your body rejecting it, since it recognises the tissue as its own.

Are there different types of surgical approaches?

• Your own bone (autograft): taken from elsewhere in your body, often your jaw or chin for smaller dental grafts, or your hip for larger grafts. This is often seen as the best option because it contains living bone cells and carries the lowest risk of rejection, though it means treating a second site on your body.
• Donor bone (allograft): bone from a donor bank, carefully screened and processed to reduce the risk of infection or rejection.
• Animal-derived bone (xenograft): usually from cows or pigs, processed for safe use in humans; this is one of the most widely used materials in dental bone grafting.
• Synthetic bone substitute (alloplast): a lab-made material, often based on hydroxyapatite, a mineral similar to natural bone. It avoids the need for a second surgical site, though it may not work as well as your own bone for larger areas of bone loss.

In dentistry, a minor bone graft usually takes bone from another part of your jaw under local anaesthetic, while a major bone graft takes a larger amount of bone, usually from your hip, under general anaesthetic.

What happens before the operation?

• You tell your team about any health conditions, allergies, and medicines you take
• If you smoke, you're strongly advised to stop beforehand and in the longer term, as this increases the risk of the graft failing and can slow healing
• You discuss which type of graft material is best suited to you, and where it comes from
• You sign a consent form to confirm you understand the procedure and agree to it.

What happens during the procedure?

1. You have a local anaesthetic (sometimes with sedation) for a minor graft, or a general anaesthetic for a larger graft using bone from your hip.
2. Your surgeon lifts the gum, skin, or other tissue away from the area needing treatment to see how much bone is needed.
3. If your own bone is being used, it's carefully taken from a donor site such as your jaw, chin, or hip, in small pieces or blocks.
4. The graft material, whether your own bone, donated bone, or a synthetic substitute, is packed into the area of bone loss.
5. It's sometimes covered with a protective membrane, and may be fixed in place with small pins, screws, or plates.
6. The gum or skin is put back over the graft and stitched carefully into place, and any donor site is also closed and stitched.

What does recovery look like?

In hospital

For a minor graft, you can usually go home once the procedure is finished and you feel well enough. For a larger graft using bone from your hip, you'll usually have a short stay in hospital, sometimes with a small drainage tube and pain relief given through a cannula.

At home

• Tenderness, swelling, and bruising are normal and usually settle within a week or two; over-the-counter pain relief and ice packs for the first 6 hours can help
• You should be able to eat normally quite quickly, though soft foods may be recommended for a few days for dental grafts
• Avoid alcohol for 24 hours after treatment
• If you wear dentures, you may not be able to wear them for up to 2 weeks
• For dental grafts, avoid brushing the graft site for a week and use a chlorhexidine mouthwash twice a day instead
• Small bone fragments, looking like grains of sand, may come away from the site in the first few days; this is usually nothing to worry about
• If bleeding occurs, press a clean cloth firmly over the wound for 30 minutes; go to your nearest emergency department if it doesn't stop

Initial recovery generally takes about a week, but the graft itself needs at least 3 months to heal fully, and up to 9–12 months for larger grafts. Return to work varies from 1–2 days after a minor dental graft to around a week after a graft taken from your hip, depending on how comfortable you are walking; avoid strenuous activity or sport for 3–4 weeks if bone was taken from your hip. A healed bone graft can last a lifetime, but if it's being used to prepare for a dental implant, this should usually go ahead within 6–12 months, or the new bone can start to shrink again.

What are the risks and complications?

• Pain, swelling, and bruising, which usually settle within a week or two
• Anaesthesia complications
• Infection at the graft site; across bone grafts generally, this happens in fewer than 1% of cases and is treatable with antibiotics
• Nerve damage or severe bleeding
• If bone was taken from your hip: discomfort walking for 2–4 weeks, and rarely, numbness in the thigh, a hernia at the donor site, or a hip fracture
• Signs the graft may be failing: pain or swelling that gets worse after the first week, pus or discharge, gum recession, or no improvement in bone volume
• With donor bone (allograft): a very small risk of infection being passed on.

The risk of the graft failing is higher for people who smoke, and higher if a dental implant is placed into grafted bone rather than your own natural bone. Your care team will explain your individual risks before you go ahead.