Dental Bone Grafting

Last updated: November 6, 2026·Reviewed by Soo Jin Kim, DDS

Dental bone grafting rebuilds jawbone that has thinned or shrunk, so there is enough bone to hold a dental implant and to keep the gum line full and even where a tooth is missing. Graft material is placed where bone is missing and acts as a framework that the body gradually fills with new bone of its own over several months. The material may be bone taken from elsewhere in the mouth or body, processed donor bone, animal-derived bone, or a synthetic substitute. A graft can fill a tooth socket right after an extraction (socket preservation), widen or build up a ridge that has already shrunk (ridge augmentation), or fill gaps around an implant as it is placed, and a thin membrane often covers the graft while it heals. When we remove a tooth at ConfiDental in Carlstadt, we graft and restore the site if it needs it.

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Dr. Lee, our board-certified periodontist, does bone grafting at our Carlstadt office.

Sung Min Lee, DDS

Overview

The bone that holds a tooth begins to remodel once the tooth is gone. After an extraction, the ridge loses width faster than height, with the most rapid change in the first three to six months and slower shrinkage afterward. Gum disease, infection, injury, and the removal of cysts or other lesions can also leave gaps in the jawbone. An implant needs enough surrounding bone to be held firmly, so a ridge that has become too thin or too short may need rebuilding first.

Grafting is used in three main situations. Socket preservation fills the empty socket at the time of an extraction to limit how much the ridge collapses while it heals. Ridge augmentation rebuilds a ridge that has already shrunk, either widening it (horizontal augmentation) or adding height (vertical augmentation). Smaller gaps or thin bone found while an implant is being placed can be grafted at the same visit. A sinus lift, which adds bone beneath the sinus in the upper back jaw, is a separate procedure.

Graft materials come from four main sources. An autograft is the patient's own bone, usually taken from another site in the mouth such as the chin or the back of the lower jaw (ramus), and occasionally from the hip. An allograft is human donor bone from a tissue bank that has been screened and processed. A xenograft is processed animal bone, most often bovine, and synthetic grafts are made from minerals such as calcium phosphate or hydroxyapatite. Particle grafts are often covered with a membrane, a technique called guided bone regeneration, while larger defects may be rebuilt with a solid block of bone held in place with small screws.

The graft heals before it carries an implant unless both are placed at the same visit. Initial gum healing takes about a week, and the graft itself generally needs at least three months, with larger grafts taking nine to 12 months. Once the graft has healed, an implant is generally placed within six to 12 months, since a graft left without an implant can begin to shrink.

White dental X-ray unit in a ConfiDental room, beside a cabinet and a canvas of the Empire State Building

When It's Recommended

A tooth extraction where an implant is planned later and the socket is grafted to limit collapse of the ridge
A jawbone ridge that has become too thin or too short to hold a dental implant after tooth loss
Thin bone, or part of the implant surface left uncovered by bone, at the time an implant is placed
Bone loss around teeth or missing teeth caused by gum disease, infection, or injury
A gap in the jawbone left after the removal of a cyst or other lesion
A sunken or uneven ridge that affects the appearance of the gums under a bridge or around front teeth

What are the risks of Dental Bone Grafting?

When to Avoid

Acute illness, or an active infection in the jawbone or gum at the planned graft site
Active, untreated periodontal (gum) disease

Possible risks

Pain, swelling, and bruising in the first days after surgery
Infection at the graft site
Bleeding during or after surgery
Opening of the gum incision or exposure of the membrane during healing, which can lead to partial loss of the graft
Loss of small granules of graft material from the site during the first days of healing
Shrinkage of the graft, or a graft that does not integrate, leaving too little bone for an implant and sometimes requiring repeat grafting
Nerve injury, causing numbness, tingling, or altered sensation of the lip, chin, or gums that may be temporary or persistent
Pain, altered skin sensation, or wound-healing problems at the donor site when bone is harvested from the chin, the back of the lower jaw, or the hip
Gum recession over the grafted area
Complications from local anesthesia or sedation
Complications are more common when a ridge is built up in height (vertical augmentation) than when it is widened

Who needs extra care

Smoking is reviewed during planning, because people who smoke show more complications after block (onlay) bone grafts than people who do not smoke
Antiresorptive or antiangiogenic medication, such as bisphosphonates or denosumab, is associated with a risk of medication-related osteonecrosis of the jaw after jaw surgery and is assessed before grafting is planned
Radiation therapy to the head and neck can impair healing of the jawbone and is assessed before grafting is planned
Diabetes and other chronic conditions are reviewed before surgery; how well a condition is controlled generally matters more than the diagnosis itself
Blood-thinning medication and bleeding disorders are reviewed before surgery
Preferences about human-donor or animal-derived graft and membrane materials are discussed during planning, since the patient's own bone or a synthetic material can be used instead

What to Expect During Treatment

A consultation reviews your dental and medical history and medications, examines the gums and the area that needs more bone, and discusses the tooth replacement you want
Imaging, often a cone-beam CT scan, measures the height and width of the bone and shows nearby structures such as the nerve canal in the lower jaw and the sinus in the upper jaw
The graft material, and whether a membrane is needed, is chosen from the size and shape of the defect and discussed with you, including any preferences about donor or animal-derived materials
On the day of surgery, local anesthetic numbs the area, and some people also have sedation
For socket preservation, the tooth is removed and the empty socket is filled with graft material right away
For ridge augmentation, a small incision lets the gum be lifted back from the bone, and the area is cleaned before the graft material is placed where bone is missing
When your own bone is used, a small amount is taken from another site, often within the mouth, such as the chin or the back of the lower jaw
A membrane is often laid over the graft to protect it and keep gum tissue out while bone forms, and a block graft is held in place with small screws
The gum is repositioned and closed with stitches
A follow-up visit checks early healing and removes stitches that do not dissolve on their own
Over the following months, the graft heals and imaging confirms the new bone before an implant is placed, unless the implant was placed at the same visit

How does Dental Bone Grafting work?

A bone graft gives new bone a framework to grow into. All graft materials are osteoconductive, meaning bone-forming cells from the surrounding jaw can attach to the graft and lay down new bone along it. The patient's own bone also carries living bone-forming cells (osteogenesis) and growth factors that stimulate bone formation (osteoinduction), and some processed donor bone retains osteoinductive properties.

Over the following months the body gradually remodels the graft, replacing much of it with its own bone. Some materials, such as processed bovine bone, resorb slowly and help hold the volume of the rebuilt ridge, while others are replaced more quickly.
Gum tissue grows faster than bone and can fill a defect before bone does. In guided bone regeneration, a membrane placed over the graft keeps soft tissue out of the space so bone can fill it. Resorbable membranes, often made of collagen, dissolve on their own, while non-resorbable membranes are removed in a later step.
In socket preservation, the graft fills the socket immediately after the tooth is removed, supporting the walls of the ridge while the socket heals. In ridge augmentation, particles of graft under a membrane or a solid block of bone fixed with small screws add width or height to a ridge that has already shrunk.
Both kinds of graft described above are Dr. Lee's work here, and she is also the dentist who later places the implant into the rebuilt bone. Her grafting covers ridge preservation, filling the socket at the visit a tooth comes out, and rebuilding a ridge that has already thinned.

Recovery & Aftercare

Initial recovery takes about a week, and tenderness, swelling, and bruising usually fade within one to two weeks
Some people notice small, sand-like granules of graft material in the mouth during the first few days, which is a common part of healing
You may be advised to eat soft foods and to avoid chewing on the grafted side while the site heals
Tobacco use can slow healing of the graft site
The graft generally needs at least three months to heal, and large grafts can take nine to 12 months, before an implant is placed
Once the graft has healed, an implant is generally placed within six to 12 months, since a graft left without an implant can begin to shrink
If you notice a fever of 101°F (38.3°C) or higher, swelling that increases after the first few days, pus around the graft site, or severe pain, contact the dental office that performed the graft promptly

Alternative Treatments

Short or narrow implants placed in the existing bone, where the remaining bone allows
Angled implants in a full-arch (All-on-X) plan, which can reach firmer bone in some jaws
Zygomatic implants anchored in the cheekbone for a severely resorbed upper jaw
Distraction osteogenesis, which gradually lengthens the existing bone to gain height
A conventional fixed bridge supported by crowns on the neighboring teeth
A removable partial or complete denture

What the Research Says

Re-entry studies in people have measured a loss of 29% to 63% of the jawbone ridge's width in the six months after a tooth extraction[5]
A 2021 Cochrane review of randomized trials concluded that ridge preservation techniques may limit loss of ridge height and width at six months after an extraction[3]
Bone graft materials come from four main sources: the patient's own bone (autograft), human donor bone (allograft), animal bone (xenograft), and synthetic substitutes[6]
In guided bone regeneration, a membrane over the graft keeps faster-growing soft tissue out of the space where new bone is forming[7]
A prospective study following implants placed with guided bone regeneration for 12 to 14 years reported cumulative implant survival of about 92%[8]

About Our Clinicians

Sung Min Lee

DDS

Does the bone graft and then places the implant.

Board-certified periodontist specializing in gum disease treatment and dental implant surgery

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Frequently Asked Questions

What is a dental bone graft?

A dental bone graft rebuilds jawbone that has thinned or shrunk, most often so there is enough bone to hold a dental implant. Graft material is placed where bone is missing, and over several months the body grows its own bone into it. It can fill a socket right after an extraction, rebuild a ridge that has already shrunk, or fill gaps around an implant as it is placed.

Does a dental bone graft hurt?

Local anesthetic numbs the area before grafting begins, and some people also have sedation. Most people who have a dental bone graft report little to no pain afterward, although tenderness, swelling, and bruising are common for a week or two and are usually managed with over-the-counter or prescribed pain relief. When your own bone is used, the site it is taken from can also be sore.

Is dental bone grafting safe?

Dental bone grafting is generally considered safe and is a common step in preparing for implants. Donor and animal-derived materials come from tissue banks that screen and process them before use. A health review before surgery checks the gums, the bone, and any medical conditions or medications that affect healing. Specific risks are listed in the risks section.

How long after a bone graft is an implant placed?

A graft generally needs at least three months to heal before an implant goes in, and large grafts can take nine to 12 months. Smaller grafts are sometimes placed at the same visit as the implant, so both heal together. Once a graft has healed, an implant is generally placed within six to 12 months, because a graft left without an implant can begin to shrink.

What happens during a dental bone graft?

Once the area is numbed, the graft material is either placed straight into the socket of a tooth that has just been removed, or the gum is gently lifted back so the material can be placed where the ridge has shrunk. A membrane is often laid over the graft to protect it, and the gum is closed with stitches. Most people go home the same day with instructions for eating, cleaning, and pain relief.

Who is not a candidate for a dental bone graft?

Grafting is generally put off for people with an acute illness, an active infection in the jaw or gums at the planned site, or gum disease that has not yet been treated. Once the infection or gum disease is under control, grafting can be reconsidered.

What are dental bone grafts made of?

Graft material can be your own bone, usually taken from elsewhere in the mouth, human donor bone from a tissue bank, processed animal bone, most often bovine, or a synthetic mineral such as calcium phosphate. Each acts as a framework for new bone, and your own bone also brings living bone-forming cells. The choice depends on the size and shape of the defect and on your preferences.

Do I need a bone graft after a tooth extraction?

Not always. Filling the empty socket when a tooth is removed, called socket preservation, is mainly for a site where an implant is planned later, because the ridge loses width fastest in the first months after an extraction and the graft limits how far it collapses. Dr. Lee does this ridge preservation here, and tooth extraction covers the extraction itself.

Does a bone graft add to the cost of dental implants?

When a site needs one, yes. The graft is its own procedure, placed before the implant or at the same visit, which makes it part of the implant plan and its total. For the other things that change it, see the cost of dental implants.

Sources & References

This article draws from 14 peer-reviewed sources.

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