Bone Grafting Masterclass
Why Do We Graft?
After a tooth is extracted, the alveolar ridge undergoes significant atrophy—like a deflated balloon. Without intervention, this natural resorption compromises future implant stability and aesthetics.
- 📉 50% width loss occurs within the first year post-extraction.
- ⚠️ 2/3 of that loss happens in the first 3 months.
- 🛡️ Preservation reduces the need for major augmentation later by 5x.
Projected Bone Resorption (Untreated)
Source: nature.com / clinical data aggregates
Biological Principles
Understanding the “Rules of the Game”: How bone heals and the definitions that drive material selection.
Osteoconduction
The Scaffold. A passive trellis for new bone to climb on. All grafts must provide this.
Osteoinduction
The Signal. Recruits immature stem cells and tells them to become bone-forming cells (e.g., BMPs).
Osteogenesis
The Factory. Living cells transplanted to the site that directly produce bone. (Only Autograft).
The Wound Healing Cascade
Hemostasis & Coagulation
Key Events
Blood fills the socket. Platelets aggregate and degranulate, releasing growth factors. Fibrin clot forms, creating the initial provisional matrix.
Key Players
Platelets, Fibrin, PDGF, TGF-β, VEGF.
Clinical Note: This is why stability is key. If the clot is disturbed mechanically, the entire cascade is disrupted.
Graft Material Selection
Explore the “Bricks” of bone building. Select a material to view details.
Biologic Additives
Clinical Protocols & Techniques
Implant Placement Timing
Timing is a balance between soft tissue healing, bone maturity, and preventing resorption. The ITI consensus defines four types of placement.
Immediate
0 Days (At extraction)
- • Preserves ridge form internally.
- • Requires intact socket walls.
- • Good primary stability needed.
Early (Soft Tissue)
4-8 Weeks
- • Soft tissue is healed (closure easier).
- • Pathology resolved.
- • Bundle bone resorption has begun.
Early (Bone Healing)
12-16 Weeks
- • Significant woven bone fill.
- • Better stability than Type 2.
- • Allows for simultaneous GBR if needed.
Delayed
> 6 Months
- • Fully mature bone.
- • Often significant ridge atrophy if not preserved.
- • Used for large defects needing staging.