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What is a “Block Bone Graft” Associated with Dental Implants? — Video

UPDATE TO THIS POST —-CLICK HERE

Many patients have come to me for second opinions about bone grafts. Specifically, they were told they need a "block graft" or "onlay graft."

Although this procedure is popular and works well, there is not a lot of patient information available about it.

This video should give you a good understanding of the procedure.

There are also many alternatives to this procedure

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42 thoughts on “What is a “Block Bone Graft” Associated with Dental Implants? — Video

  1. Hello Dr Amin, I recently had a cyst removal (above the tip of the root), extraction of that tooth, bone graft and immediate implant placement with cover screw at UR2 (as it wasnt infected) at the beginning of April. I need a root canal on molar UR6 – how long should I wait until I have this done – is it too soon to have it done now – im not in a lot of pain or anything but CT scan indicated I need it doing. If so how long is not too soon? I dont want it to ruin the success of all the work at the implant site. Thanks :@)

    1. These are separate areas and they are not right next to each other so the timing is not as critical. If you have a bad tooth next to the implant tooth or bone graft then it becomes much more immediate to have the root canal done so that it does not affect the healing bone graft or dental implant.

      1. Thank you Dr!! They have decided to monitor the already root canalled tooth as they are unsure if what the ct scan is showing is old scar tissue from the old infection ten years ago. Since the tooth doesn’t present pain. Just tenderness on a bony lump above the root when I press it which they say can be something that presents after a deep root filling. Like a callous on a foot. So….As my implant will be uncovered after six months and a temp crown put on…. If I do need root canal a month or so after that if it gets worse…. Will the impressions for the new crown affect the newly exposed implant. Impressions always feel like they’re going to take my teeth out and id be worried about it moving the new implant tooth? Thanks

        1. I prefer to use digital impressions. This is a video scan of her mouth without having to use any molding material. This is what I use in my practice.

          1. Wow. I’ve never heard of those being used in the uk. If they are it’s very new. Have you done any videos or posts on what you think will be the future of dental implants and bone grafting in the next ten to fifteen years. I hear a lot about stem cells etc. It’s really good to know what the advances may be in the future :@)

  2. Hi Dr, Amin

    Thank you for your informational videos. I wish I could afford to fly to CA to see you.
    I have a missing molar, 2nd to last on my left lower jaw. I recently saw the only physician in my area who advises a bone block graft. I know he is a good surgeon,but he says he doesn’t use CAT scans. Should I be worried?

    1. I don’t think any prudent dentist implant surgeon would do that type of procedure without a scan in the year 2015. Even back in the early 2000’s before the age of in office 3-D scanning, I use to send my patients to the hospital to have a scan done. I’m sure a local hospital or x-ray lab can perform a 3-D scan for you….. But the main thing is that your surgeon knows how to read it and is comfortable doing the interpretation. You have to be able to use the scan for virtual planning not just view it.

      Ramsey Amin DDS

  3. Hello Doctor,

    I am about a month away from getting bone grafts on the bottom left side of my jaw so that my jaw may sustain four dental implants. I’ve been missing the teeth for about five years. As such, much of the bone has shrunk away, and the contours of my face have changed. I’m wondering, which type of bone grafts, if any, will return the volume and structure to my face?

    Many Thanks,
    Cai

    1. Hi Cai,

      I believe I answered your question and a different blog post, so here is that same answer.

      Also this updated post about block bone grafting has been updated. I would highly suggest you reviewed this particular post about block grafting.

      Hi Cai,

      It sounds like you have a combination of vertical and horizontal bone loss in the lower back jaw. This is a particularly difficult area to build back especially if the bone is lost vertically. Many female patients that have been facial bone structure and thin skin may have a more collapsed appearance when teeth are lost.

      Without seeing you and a 3-D scan, it would be impossible for me to tell you exactly what to do. Try having and inexpensive removable temporary partial denture called a flipper made. If this filled in the space, then having implants in the area should do the same. The design is going to have to be critical on the teeth to be able to fill in the facial voids. You may even need some pink porcelain if the teeth are tall and vertical bone cannot be rebuilt. Sometimes these areas are so bad that a nerve repositioning needs to be done.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  4. I had a root pulled in the upper left side of my mouth about 2 weeks ago. I know that feeling some small bone granules in your mouth from time to time is normal and it looks as though the sutures has started to dissolve. When I took a look at it there some thick white substance that look as if it came from the socket. Is this normal or is my bone graft coming out?

  5. Please be advise it that normal still swollen from block bonegraft since 17 days ago!! Will it change my profile! I fell the distance from my nose to my lips it look bulky!!!when I touch both side of my nose feel hard! is that cause still swollen!!should I get 2 dental implant or 4 implant!! Thanks Dr Ramsey!!

    1. This is my guess: You may have been used to the appearance of bone loss. Now all of the sudden, the normal contours are restored and it looks weird to you. If the the bone blocks were big give it one month to smooth out from swelling.

      Changing profile for the negative is very rare. Some people have very thin skin and they can tell, but the majority can not tell a difference from the outside.

      I hope this helps.

    2. Hello dr Ramsey thank you for your 1st reply to my question I m in 1 mos of my block bone graft the dentist filed in 6mm cadaver allograft building the widlth of my instead if 4mm as original plan!!do u think by doing that it make the distance from my nose to my lips longer and bulky I’m not happy w the way it look right now??with in six mos waiting for bonegaft to integrated will I have my nature look back at the end result and do u think it too crowded to have 4 single implants for my front teeth or 2 implant w a bridge I care about my pretty face more than perfect teeth with an ugly face!! Hu hu !!
      I m very appreciated It thank you dr Ramsey!!!

    3. Hi Michelle,

      If it was a huge graft you could have minor swelling for 4 weeks. How is it now?

      2 versus 4 dental implants is going to be determined by the distance between each implant. He want to have a minimum of 3 mm between each implant. You also have to determine whether your gum is thick or thin and whether you have a high or low scallop style of tissue. Of course these are things your dentist has to help you decipher. If this choices made incorrectly, your teeth will look very square which is okay if your other teeth are very square. Most of the time people don’t have room for 4 dental implants and 2 of them and up looking better if we are talking about the 4 front teeth.

      Sorry for the delayed reply. My blog had about 200 spam comments which has now been fixed. Your comment got mixed into those 200 comments.

  6. Has anyone had any/much experience with Auto transplantation. I started the process of an implant a few months ago and after putting the bone material in, waiting a few weeks and then putting in the implant post, the post fell out. For reasons I don’t understand the bone material is not working and I am now being given the option of a block graft, a full sinus graft or pulling one of my unused wisdom teeth and inserting that in the space where the tooth is missing. This is the procedure my dentist is saying will work best

    1. Hi Jim,
      Auto transplants do not work. They have been tried many years ago. It is not a new idea. I believe there may be some ability for this to work in the pediatric population in an extremely rare indication. I am guessing you and your dentist had a misunderstanding.

      Bone grafting, when done properly in a healthy patient is extremely predictable.

      Respectfully

      Dr. Amin.

  7. Hi Dr. Ramsey. I am about to do my implants in 2 days. My doctor said that he will do bone graft and 6 implants at the same time. I have been wearing denture since I was 13 and am now 40. Based on what I read in the net it takes 4-6 months For bone graft to Heal before placing the implants. I am now worried that my implants will fail because of what he will do. But he is very confident that he can do both at the same time. Could you enlighten me please. Thanks. -Anne-

    1. Hi Anne,

      It is really common to do a simultaneous bone graft and dental implant placement. Oftentimes this is beneficial because the dental implant occupies space and bone can be added to the outer wall. This is called guided bone regeneration abbreviated GBR. Oftentimes this is combined with a membrane made of collagen or my preference would be to use platelet rich fibrin abbreviated as PRF.

      Sometimes it is a really bad idea to do a bone graft and simultaneous dental implant. So the reality is that it is a case-by-case decision that needs to be made very carefully. Some bone grafts are much larger than others and require much longer healing periods. Some bone grafts are very tiny. Some of the bone grafts I do go all the way from 1 molar always across the front of the jaw all the way to the other side. Sometimes involve titanium mesh or bone fixation screws such as an onlay block bone graft.

      I’m sure you are in good hands. Good luck to you. Please keep me posted in reference your original post when you reply. I would definitely suggest a round of antibiotics if you’re having both dental implants and bone grafting done simultaneously. Make sure to watch the antibiotics video. It is short and very helpful.

      These web links may help:
      Burbank Implant Dentist Explains Titanium Mesh Bone Grafting for Dental Implants
      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?
      What Is A Membrane? Do I Need One For My Implant Bone Graft? My Membrane Fell Out/Sticking Out And Exposed
      Antibiotics for a Tooth Infection, Dental Implant, Bone Graft… Do I Need Them? 

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  8. Dr Amin. I now got my three implants on my lower jaw back bone. All in one raw. Before the implants, I had block bone graft because of the narrowness. My doctor attached chunky size of bone to the outer side of my narrow bone to make it wider. It healed and integrated well but there was always a degree of unhappiness because I felt it was too bulky. There was only a minor assymetry after the block bone graft, but I could feel it and get annoyed. I always hoped that my dentist would shave excess bone during the placement of implant. But guess what, he didn’t and in addition to it he placed there an IMLANT looking horribly misaligned from the rest of the teeth. I am going to ask him remove that cursed implant in one month. The other two is bearable but not perfectly positioned either. Do you think it’s a good idea that I ask him to remove it? I would rather be toothless! What would be the best option for me? I know marrying you is the best option 🙂 but I would be happy even if you just address my questions. Many thanks beforehand! 🙂

    1. Hello Olivia,

      You are too funny… LOL. I am already married!!

      It is always better to have more bone than last bone. The reason why is some bone graft shrinkage is expected that will happen naturally. Having an excessive amount of bone on the outer wall of your dental implants will help long-term stability and prevent you from developing a condition called peri-implantitis.
      What is Peri-implantitis and What Do I Do About It? – Bone Loss Around Dental Implants ~Burbank Dentist, Ramsey Amin Reviews

      Just by looking in your mouth, you cannot judge the position of the implants. Your dentist likely has a reason for the positioning of the implants. Sometimes dental implants are placed on a purposeful tilted and sometimes they’re placed straight up and down. Generally speaking there should be some space between them. If the crowns are on the teeth yet, a lay person would have a difficult time assessing whether the implants are in proper position or not. Removing dental implants would be a last resort if the implants were truly placed in a very poor position that could not be corrected with a custom abutment. Sometimes dental implants are placed slightly off axis to engage the most volume of the available bone. So even though they may look horribly misaligned right now, they may indeed turn out perfectly. I am only speculating of course because I have never seen you.
      Do I Need Custom Dental Implant Abutments?

      The excessive bone can be trimmed back at any time if it really causes you an issue. Unless your skin is very thin, it would be unlikely that you can see a facial change from a dental bone graft.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

    2. Olivia
      who is your bonegraft specialist? I would love to go see him. I am missing tons of bone and surgeons are telling me its beyond their scope of work. They can’t help me. Please let me know asap. Thanks

  9. Dr. Ramsey,
    I am in need of some serious advice! I had an apicoectomy on my 4 front teeth (7,8,9,10) back in the late 70’s. I had all four teeth capped in or around 2002. For the past seven years I’ve been having problems with these 4 capped teeth (loose and cracking). II finally decided to start the process towards implants. I met with an oral surgeon who removed # 8 in May 2014. The surgeon packed it with bone graft but there is a pretty big gap/hole there. Now I’m wearing a flipper (which I absolutely hate, and it doesn’t fit). My gums are pulling away from the remaining caps. Now, more than ever, I want to get the ball rolling in the directions of implants. The oral surgeon who removed my tooth #8 says that I have a “high smile line”. He said he is concerned with the outcome being a “very long tooth” appearance in the front of my mouth. He mentioned my other three caps being loose. I said that I am fine with removing them and putting in implants. Initially, he said that we could do two implants with an additional tooth attached to each implant which would replace these four teeth. That was our original plan. Now he suggest doing a bridge instead. He doesn’t sound assured that I will be happy with the end result. He emphasized the pain, money and inconvenience. What do you think? I live in Westchester, New York. Do you have anyone you would suggest for a second opinion? I am aware that we are talking about money, time and pain but what would you do if it was your mouth?

    1. Hello Penny,

      If you’re having your dental implants done by 2 different providers, the dentist making the teeth should be the one directing where and how many implants are put in. If you have a separate oral surgeon and a separate dentist, one may be far more experience than the other.

      There is no doubt that a patient with a very high smile line is far more challenging to get an excellent result. I would suggest to take it slow and predictable route rather than try to speed through every step. With the high smile line, make only one miracle at a time.

      I don’t know anybody personally in your area, but I would suggest you find Diplomate of the American Board of Oral Implantology or a Fellow of the American Academy of Implant Dentistry.
      Your case would be considered more difficult. Good luck with everything!

      Dr. Amin

  10. I had sinus lift surgery on June 19 the and my oral surgeon says I need additional grafting to build height and width of the area. I realize that taking my own bone for this would be the best but o am concerned with the recuperation and amount of pain of the donor site (the hip). What has been your experience with patients that have undergone bone removal from the hip?

    1. Hello Shirley,

      Bone grafting from the hip is not very common anymore. I did quite a bit of it during my residency training. It is call the iliac crest bone graft.

      Nowadays most things can be done with cadaver allograft including major bone block onlay grafting with screws to fixate the bone in place. There is a much reduced morbidity by a not going to the hospital and removing bone from your hip. I would strongly suggest another consultation with a dentist who is very skilled and bone grafting for implant dentistry utilizing allograft bone blocks. I do this all the time. I also take bone from patient’s own jaws when needed, but I have found that onlay bone blocks made from cadaver bone work just as well, if not even better!

      http://www.burbankdentalimplants.com/bone-grafting/

      If you’re missing all of your teeth, you are likely going to have to be without a denture for 1-2 months while the gum completely heals. For most patients this is not possible. You could consider doing it in smaller sections.

      Good luck and keep me posted.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  11. Dr Ramsey, I have to say you are a wonderful person, your advices are so helpful. As mentioned in my earlier posts, i had block bone graft for dental implants because my low back jaw bone was too narrow. More than nine month has passed since the surgery and the bone seems to be well integrated as confirmed by many doctors. Now its time to do the implants. I plan to have three in a row (yes i lost my 3 teeth accidentally too early, im 29 now). Im so worried now because i am afraid that Inferior alveolar or mandibular or whatsoever nerve can be damaged from excessive local anesthesia during the surgery that i had before or from future implants . So i have two questions:
    1) Is it better/safer to have 3 implants on a row or 2 with a bridge? My doctor says 3 is better but its profitble for doctors to say so. So i need your second opinion.
    2) question is about nerve damage either from block bone surgery or Implants. I realised that i have altered sensation (very little) in the area where bone was grafted (lower chin). Im now panicking that maybe the screws used for block bone just punctured my nerve tissues or something horrible happened that im not aware of. Im now planning to go to micro nerve specialist to check if my nerves on lower jaw got any injuries. How safe is bone graft and implants with regard to Nerve locations.? Do dentists actually study the nerve system of the jaw bone?

    1. hello Olivia again 😉

      Thank you for your very kind words. I will try to answer some of your questions. It sounds like you of seen a lot of doctors and really should stay focused with just one.

      if the implants are on your upper jaw, he may want to consider having one implant per tooth due to the softer bone in this jaw. If the implants are on your lower jaw where the bone is more dense, 2 implants and a bridge may be deemed suitable if the bone is strong and thick. It is always better to have more supporting implants than less supporting implants.

      Dentist who do dental implant and bone grafting need to be well-versed in anatomy of the jaws. There are nerves and arteries that traversed through the jaws that need to be avoided or sometimes moved out of the way in order to do proper treatment. A dentist must no anatomy very well especially when getting involved in complex bone grafting.

      http://www.burbankdentalimplants.com/nerve-repositioning-lateralization/

      Respectfully,
      Ramsey Amin DDS

  12. Hi. I had block bone graft 4 month ago on my law jaw bone for future implants as I had too thin jaw bone.. Doctor put extra large bone (bio oss) saying that some of its volume will shrink. 4 month passed and I still have a little bit of bulkiness on my face. I love to have symmetric facial features and that bulkiness really annoys me even though there is small difference. My first question is how i can resolve it and get rid of my bulkiness on the face? Also do you know how long the risk of block bone failure last? Can I say I’m safe because 4 month passed already?

    1. Hi Olivia,

      Extra bone is a wonderful thing! Most of the time the graft shrinks about 20% so most prudent implant dentists add extra.

      The solution…when you have the implants placed, some of the extra bone can be shaved away. This is really easy to do.

      😉
      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

    2. Olivia,

      One last thing…. Yes, usually you are in the clear once the gum has healed. That usually is about 1 month.

      Good luck.

      Dr. Amin.

  13. I have a very unique situation involving an implant (#8) that was placed 20 years ago. I have developed peri implantitis and now the implant has to be removed. Problem is that my bone has gone down to basically nothing in that area both vertically and horizontally. I have been to 4 periodontists/surgeons and have had a couple of different opinions although basically the same. First 2 were going to do bone grafts using synthetic materials, one a block bone graft and another BMP. I do not want to use BMP at all whether or not the results may be predictable. I would like to do a block bone graft using my bone because I know something substantial has to be placed in the area to avoid major shrinkage. I know without seeing me it is difficult to diagnose but would you use another method in a situation like this? Can a block bone graft and distraction be used together? Thank you for your suggestions.

    1. Hi Heather,

      A block bone graft and distraction osteogenesis can be used together, but not at the same time. This is a lot of work though.

      The block graft with guided bone regeneration should work well if done properly and you heal well. Titanium mesh works too. It sounds like the implant should have been removed long ago when the bone loss wasn’t as bad.

      I wish you the best of luck. You don’t have an easy situation. Find someone in your area with the credentials that I have and you will be in good hands.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      1. Hi Dr. Amin,

        I have another question for you. My dentist is talking about using PDGF and/or Emdogain. What are your experiences with them? Are these considered common when using guided bone regeneration? I do not want to use BMP, are these similar? Thank you in advance for your answers!

        1. Hi Heather,

          If the graft is REALLY complex, then growth factors help. If it is simple and you are healthy, your body will do what it is supposed to with good surgical technique.

          Respectfully,

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

  14. Distraction osteogenesis is another way to build height. It is the process of “stretching” bone to make more bone.
    Each situation is so different Cheryl so I cant exactly tell you what to do.
    BMP is used in conjuction with a bone graft to build new bone. It is probably not necessary.
    It is easier to build height in the upper jaw rather than the lower. Often times you can bypass building the height back and just build back the width of bone.
    The height can be corrected with some creative prosthetics and avoid complex and costly surgeries.
    I have done this for so many patients and sometimes it is te only option. I also build bone vertically when needed especially for an upper front tooth.

  15. I am in florida …
    Aside from bone grafting what else can grow bone so I can increase the height so I can get the implants done?
    What is bmp used for? Is this necessary?
    Thank you.

  16. Hi Cheryl,
    Bone expansion of the LOWER jaw is a technique that a handful of dentists do and have mastered. The upper jaw is easier to expand.
    In my opinion, it is the very best for long term crestal bone stabilty.
    More important than the type of bone used is that it is the right type for YOUR situation. Surgical technique of your dentist is critical to the result.
    If you reside in my area, please come in for an exam and maybe I can help you.

  17. I emailed you in another section of your presentation. I do not think that there are dentists in my area that do bone expansion process for the width needed in my case.
    What other bone growth materials can be used that will grow bone width versus doing a bone graft or bone expansion process?
    This is for the lower back right teeth to place a 3 implant bridge once my last tooth is removed.
    Thank you for your suggestions.

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About Ramsey A. Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.