Dental Bone Grafts: What They Are and Why You Might Need One Before Implants
A dental bone graft adds bone to your jaw where it's worn thin, so there's enough to hold a dental implant firmly. We talk about it most with patients who had a back tooth taken out years ago and are now ready to replace it. The gap looks fine from the outside. But on the 3D scan, the bone underneath has quietly shrunk.
That's the most common reason we recommend a graft at Appin Dental Surgery. And it's usually a smaller procedure than people expect. Below, we cover what a bone graft in the mouth involves, when you need one, when you don't, and what healing looks like week by week.
What Is a Dental Bone Graft?
A dental bone graft is a minor surgical procedure where bone, or a bone-like material, is placed into a thin or missing part of your jaw. Over the following months, your body grows its own new bone through and around it. The graft acts as a scaffold. Your bone does the rest.
Most of the time we're grafting the alveolar ridge (that's the horseshoe-shaped ridge of jawbone your teeth sit in). Either we're stopping it from shrinking after an extraction, or we're rebuilding it before an implant goes in. You might also hear it called an oral bone graft or a tooth bone graft, though the graft goes into the jaw, not the tooth itself.
Where Does the Graft Material Come From?
There are four main sources of dental bone graft material:
Type | Where it comes from | What to know |
Autograft | Your own bone, usually from elsewhere in the jaw | Contains living bone cells, but needs a second surgical site |
Allograft | Donated human bone, processed by a tissue bank | No second site; screened and sterilised |
Xenograft | Animal bone, most often bovine (cow) | Processed until only the mineral framework is left; very widely used |
Alloplast (synthetic) | Lab-made, such as hydroxyapatite | No human or animal source |
In everyday dentistry, xenografts and allografts are the most common choices. They're often covered with a thin collagen membrane that keeps gum tissue out while the bone fills in. A 2013 review of bone grafts in dentistry explains how each type helps new bone form. Every material we use at Appin Dental Surgery is TGA-approved.
Why Does Your Jawbone Shrink After a Tooth Comes Out?
Your jawbone shrinks after an extraction because the tooth root was what kept it working. Every time you chew, the root passes pressure into the bone. Bone that stops getting that pressure is slowly broken down and reabsorbed by the body.
It happens faster than most people think. A systematic review by Tan and colleagues found the ridge loses 29 to 63% of its width and 11 to 22% of its height in the six months after an extraction, with the fastest change in the first three to six months.
So what does that mean for you? If you wait a year or two to replace a molar, there may be noticeably less bone to work with than on the day it came out.
We see this a lot with patients across Wollondilly who had a tooth removed in a hurry, with a plan to sort it out later. Life gets busy. That's normal. It just means the conversation now includes a graft. If you've got an extraction coming up, ask us about socket preservation at the same visit (more on that below), and you can read what to expect during a tooth extraction before you come in.
Gum disease does the same damage from a different direction. Advanced gum disease (periodontitis) breaks down the bone around teeth, which is why we check bone levels as part of our gum disease treatment. It usually starts as gingivitis, which we explain in our guide to why your gums bleed.
Do You Always Need a Bone Graft Before an Implant?
No. Plenty of people have enough bone for an implant without any grafting. The only way to know whether bone grafting is needed is a 3D scan called a CBCT, which shows the height, width and density of bone where the implant would sit.
A graft is more likely when:
The tooth came out more than a few months ago and the ridge has narrowed
Gum disease has caused bone loss around the area
It's an upper back tooth and the sinus has dropped down into the space
It's a front tooth, where the outer wall of bone is naturally very thin
An infection, cyst or injury has destroyed bone, or an impacted wisdom tooth has damaged the bone behind a molar (we cover this in our post on when wisdom teeth should come out)
If you'd rather avoid a graft, there are sometimes other paths. A shorter or narrower implant, or angling the implant into better bone, can work in the right case. A dental bridge or custom-fitted dentures are options too. For severe upper jaw bone loss, zygomatic implants (anchored into the cheekbone) are another route, and we refer those cases to an oral and maxillofacial surgeon we work closely with.
Our view? If you're a good implant candidate and the graft is small, it's usually worth doing. Bridges and dentures don't stop the bone underneath from shrinking.
What Are the Main Types of Bone Graft in the Mouth?
There are four main types of bone graft in the mouth. Which one you need depends on where the bone is missing and how much has gone.
Socket Preservation (Graft at Extraction)
Graft material goes into the empty socket straight after extraction, while the bone walls are still there to hold it. A 2018 meta-analysis by Bassir and colleagues found preserved sites kept about 1.9 mm more width than sockets left to heal on their own. Sounds tiny. In implant terms, it can be the difference between needing a bigger graft later or not.
Ridge Augmentation
This rebuilds the width or height of a ridge that's already narrowed. Graft material is placed against the bone and covered with a membrane, a technique called guided bone regeneration. If there's enough bone to hold the implant steady, this can sometimes be done in the same appointment as the implant.
Sinus Lift
A sinus lift adds bone under the floor of the sinus, above your upper back teeth. The upper molars are where we most often run into this. After a molar is lost, the sinus tends to expand down into the space, and sometimes only a few millimetres of bone are left.
Block Graft
A block graft is a larger piece of bone, usually your own, fixed in place to rebuild a big defect. It's a bigger procedure with a longer healing time.
Smaller grafts, like socket preservation and minor ridge grafts, are often done in the dental chair under local anaesthetic. Larger block grafts and complex sinus lifts may be referred to an oral and maxillofacial surgeon. We'll tell you which applies once we've seen your scan, and you can read more about the oral surgery procedures we do in Appin.
Does a Dental Bone Graft Hurt?
Most patients find a dental bone graft less uncomfortable than they expected, and fairly similar to having a tooth out. It's done under local anaesthetic, so you'll feel pressure during the procedure rather than pain.
Afterwards, expect tenderness and some swelling for 3 to 5 days, usually worst around day 2 or 3. Over-the-counter pain relief is enough for most people. If you're nervous, tell us beforehand. We'd much rather plan for it than have you gripping the armrests.
Dental Bone Graft Healing Stages: What's Normal, Week by Week
The gum over a dental bone graft usually heals in 1 to 2 weeks. The bone underneath takes 3 to 6 months to mature, and up to 9 to 12 months for larger grafts or sinus lifts.
Stage | What's normal | What helps |
Days 1 to 3 | Swelling, tenderness, slight oozing | Cold pack (20 minutes on, 20 off), soft cool foods, rest; no heavy exercise for 48 to 72 hours |
Days 4 to 7 | Swelling settling; a few gritty granules in your mouth | Gentle salt water rinses if we've advised them, chew on the other side |
Week 2 | Stitches dissolve or come out; gum closing over | Most normal foods, still careful at the site |
Weeks 3 to 6 | Gum looks healed, bone still soft underneath | Normal brushing; no denture pressing on the area unless we've adjusted it |
Months 3 to 9+ | Graft becoming your own bone | Review scan before the implant |
The gritty bits catch a lot of people off guard. We get calls about it in the first week all the time. Small, sand-like granules coming out is common and is usually just spare material from the surface. A steady stream of it, or a membrane showing through the gum, is worth a call.
Smoking and vaping both cut blood flow to the area. In our experience, smokers tend to heal more slowly after grafting, so we ask patients not to smoke or vape for at least the first week, and longer if you can manage it. Skip alcohol for the first few days. Skip straws too.
How Can You Tell If a Bone Graft Isn't Healing Properly?
Most grafts heal without problems. The warning signs are pain or swelling that gets worse after day 3 or 4 instead of better, and anything that looks like infection:
Pain that increases after the third or fourth day
Swelling that spreads, or comes back after settling
Pus, or a bad taste or smell from the site that won't go away
A temperature of 38°C or higher
Gum pulling back to expose the membrane or a large amount of graft
Numbness that hasn't worn off by the next day
Call us on (02) 9068 1369 if you notice any of these. Problems caught early can usually be managed, sometimes with antibiotics, sometimes by cleaning the site and regrafting later. The infection signs overlap with an abscess, which we explain in our post on dental abscess signs and causes.
Which Medications and Health Conditions Matter Before a Graft?
Tell your dentist about every medication you take before a bone graft, especially osteoporosis medicines like denosumab (Prolia) or bisphosphonates. These can affect how the jawbone heals after surgery.
That doesn't automatically rule grafting out. It means we plan around it, and sometimes check in with your GP first. Please don't stop any medication on your own.
A few other things change the plan:
Diabetes: well-controlled diabetes usually heals fine; poorly controlled blood sugar slows healing
Smoking and vaping: slower healing, as above
Active gum disease: we treat this first, because grafting into infected tissue doesn't hold up well
Blood thinners: usually managed rather than stopped, after talking to your doctor
Pregnancy: we generally hold off elective grafting until after the baby arrives
This is why your first appointment includes a full medical history, not just a look in your mouth.
What Affects the Cost of a Bone Graft in Australia?
The cost of a dental bone graft depends on the type of graft, how much material is needed, whether a membrane is used, and whether it's done at the same visit as an extraction or implant.
On a quote, a graft is usually listed as ADA item 243 (osseous graft, per tooth or implant), with item 236 added if a guided tissue regeneration membrane is used. These numbers come from the Australian Dental Association's schedule of dental services, and they're what your health fund uses to calculate a rebate.
Most extras policies treat grafting as major dental, so your rebate depends on your level of cover and any waiting periods. Medicare generally doesn't cover dental grafts done in a dental clinic. Ask your fund what it pays on items 243 and 236 before you book, and we'll give you a written quote after your scan. We also offer payment plans, including Afterpay and Humm.
Planning an Implant? Here's How We Work It Out at Appin
If you're weighing up an implant and wondering whether you'll need a dental bone graft first, start with a consultation and a CBCT scan. We'll show you the bone on screen, explain whether a graft is needed, and give you the full timeline and quote in writing.
You can see how we plan dental implants at our Appin clinic and book from there.
Appin Dental Surgery carries on a 30+ year legacy of caring for Macarthur families through our sister practice, Bradbury Dental Surgery. We're a QIP-accredited, ADA member practice, and families come to us from right across Wollondilly, including Picton, Tahmoor and the growing estates in Wilton and Bingara Gorge.
Wondering Whether You'll Need a Graft?
Got a gap you're thinking about filling, or an extraction coming up? It's worth asking about bone before anything else. We assess patients for a dental bone graft regularly at Appin Dental Surgery and can usually tell you in one visit whether you'll need one. Call us on (02) 9068 1369 or book online through HealthEngine.
Frequently Asked Questions
Can a bone graft and an implant be done at the same time?
Often, yes. If there's enough bone to hold the implant steady while it fuses with the bone (a process called osseointegration), a small graft can be placed around it in the same appointment. If there isn't, the graft goes in first and the implant follows once it's healed.
How long after a dental bone graft can you get an implant?
For a bone graft for an implant site, it's usually 3 to 6 months, and up to 9 to 12 months for larger grafts or sinus lifts. We confirm with a scan before placing the implant. Leaving it much longer than a year isn't ideal, because unused graft bone can slowly thin out.
How long after a dental bone graft can you eat?
You can eat soft, cool foods the same day once the numbness wears off. Stick to soft foods for about a week, chew on the other side, and keep hard, crunchy or very hot food away from the site.
Is bone graft material from cows safe?
Bovine grafts are among the most widely used and studied graft materials in dentistry. The bone is processed until only the mineral framework is left, with no living cells, and any material we use is TGA-approved.
Does a dental bone graft last forever?
Once healed, the graft has mostly been replaced by your own bone, so it behaves like the rest of your jaw. That bone still needs an implant or tooth root to keep it loaded; otherwise, it can slowly shrink again over the years.
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