Bone Augmentation vs Regeneration:
Choosing the Right Approach for Your Dental Implants

When considering dental implants, one of the most critical decisions you’ll face is whether to use a bone graft. As you are presented with your options, you may hear the terms “Augmentation” and “Regeneration”. Augmentation and regeneration are very different terms, yet dentists tend to use them interchangeably. Understanding the difference between bone augmentation and regeneration can help you make an informed choice about your dental health. But first, let’s cover the basics of bone loss.

What Is Bone Loss And Why Does It Matter?

Bone loss in the jaw can occur due to various reasons, including tooth loss, periodontal disease, or trauma. When you lose a tooth, the bone that once supported it begins to deteriorate because it’s no longer being stimulated by chewing forces. Over time, this bone loss can make it difficult or even impossible to place dental implants without additional treatment.

Bone loss matters because it affects both the function and aesthetics of your smile. A strong, healthy jawbone is essential for supporting dental implants, which are artificial tooth roots that anchor replacement teeth. Without enough bone, implants may not be stable, and the overall success of your dental treatment could be compromised.

Bone Augmentation vs. Bone Regeneration: What’s the Difference?

To augment something is simply to make it larger. To regenerate something is to grow healthy vital tissue equal to the original. It should be easy to distinguish between the two terms. Bone can be augmented with metal, plastic, or any graft material that does not resorb. To regenerate bone, materials must be biocompatible and fully resorbable, resulting in bone equal to what was lost.

Bone Augmentation

  • Bone augmentation involves adding bone or a bone-like material to the jaw using various grafting materials, including cadaver bone, animal bone, or synthetic bone.
  • The goal is to prepare a particular site for dental implants, especially in areas where significant bone loss has occurred.

Bone Regeneration

  • Bone regeneration is the replacement or restoration of damaged or missing cells, tissues, organs, to normal form and function.
  • Regeneration is always also augmentation, but augmentation is seldom regeneration. Regeneration takes into consideration the quality and health of the newly formed tissue.

A finer point of bone regeneration is that simple resorption of the material is not adequate for true regeneration. For example, the bone graft material must have a biologic compound to stimulate osteoblasts to produce more bone than is found in the normal repair process. Bone repair without grafting is not equal to bone regeneration. A socket that is healed with no graft is not as healthy or as vital as normal bone, but we do know that this bone is adequate for implant support. For true regeneration to occur, you must have a biologically active process that stimulates the regenerative process, and only then can true regeneration occur.

Why Is This Important?

It is now being recognized by a number of lecturers and professors that there is an increase in implant complication and an increase in implant failure rate in augmented sites. USC has produced a paper and a video lecture showing implant failure due to bone graft failure in sites augmented with xenografts, allografts, and non-resorbable synthetics. All of the studies and all of the case presentations of implant complication and failure due to bone graft failure is being reported in augmented (not regenerated) bone.

Most of our professors and lecturers have never used science-based resorbable biocompatible materials that produce normal bone. As a result, they believe that the problem lies in the grafting process and not the graft material used.

Histologically, it is evident as to why augmented sites fail and regenerated sites do not:

No resorption of graft particles. Areas of chronic inflammation persist. Tissue showing virtually no vascularity. Sclerotic bone formation present. Why would anyone think this tissue can act like normal bone and support an implant without complications and an increased failure rate?

The reality is that the dental profession has fooled itself into thinking that the continued use of antiquated graft materials resorb and turn into normal bone in spite of the fact that all of the science proves it never remodels and there has never been histology showing normal bone produced by any allograft. When our profession makes the switch from augmentation to regeneration, it will usher in a new exciting era of tissue regeneration that will lead to our ability to return our patients back to normal form and function with predictable long term implant success.

Bone Graft Failure

In this case, dental implants were placed in sites that were augmented with Bio-Oss and allograft and subsequently failed. As seen in the center image, the augmented bone did not integrate to the implant and  bone chunk was simply picked off the threads.

implants placed in sites augmented with Bio-Oss and allograft
failed implant with augmented bone allograft. no bone to implant integration
histology of the failed allograft Bio-Oss, sclerotic bone

While this is a dramatic case of cadaver bone graft failure, most bone graft failures look very much like periimplantitis and are misdiagnosed as such. The third image is the histologic view of the failed allograft/Bio-Oss graft. If the graft worked as advertised, it would just be an image of the patient’s newly formed bone. However, there is a lack of vascularization with very few blood vessels present, there are minimal osteoblasts and no osteoclasts present, and the bone that is produced is sclerotic. Dentists continue to believe that these residual graft particles will resorb or “turn over” into normal bone eventually, but here you see the particles remain more than a decade after grafting.

Science-based Bone Grafts

As a comparison, this is a site regenerated with a resorbable, biocompatible science-based bone graft materials. Unlike the previous images, this is what healthy regenerated bone is supposed to look like.

The bone has been in function for 6 months in a regenerated periodontal defect. The bone is healthy bone capable of adapting to any load over the life of the patient. As you can see, the bone trabeculae are thick and evenly spaced and aligned according to the load placed upon them.

The pattern of bone formation and the activity of the osteoblasts with the guidance of the osteomacs shows healthy tissue regeneration at its best. This is never seen in any cadaver graft site.

Because of the abnormal tissue produced by these materials, the FDA has not cleared any cadaver bone graft or non-resorbable synthetic for implant placement. They have cleared these materials for augmentation of bone as long as you do not put an implant in the site.

Periodontal treatment outcomes have not improved in 30 years. The reason is that our profession is stuck with the misguided notion that allografts regenerate bone.

grafted site regenerated with Socket Graft
histology from socket 6 weeks after grafting with Socket Graft

To Graft Or Not To Graft?

Whether or not to use a bone graft depends on several factors, including the extent of bone loss, the location of the lost bone, and your overall health.

When Grafting is Necessary:

  • Severe Bone Loss: If you’ve lost a significant amount of bone, particularly in the upper jaw or in areas where multiple teeth are missing, grafting may be required to provide enough support for dental implants.
  • Immediate Implants: In some cases, when a tooth is extracted and an implant is placed immediately, there may not be enough bone around the implant to ensure stability. Grafting can help fill in these gaps and secure the implant.
  • Complex Cases: For patients with severe periodontal disease or those who have worn dentures for many years, bone grafting might be the only viable option to rebuild the jawbone to a level where implants can be placed.

Regardless of whether you choose to graft or not, this is something that you should discuss with your dentist as you are ultimately in charge of your healthcare decisions. Understanding the differences between bone augmentation and regeneration is key to making an informed decision about your dental treatment. While both approaches aim to restore bone health and support dental implants, the choice of whether to graft or not to graft should be based on your individual needs and goals. If you choose to graft, the type of graft material being placed into your jaw is contingent on your informed decision as well. By discussing your options with your dentist, you can ensure that you choose the treatment that’s right for you, leading to a healthier, more stable smile.

This blog post was summarized from an article intended for a professional audience of clinicians with a science and/or medical background. If you would like to further educate yourself with deeper material, read the original article here:

histology of site grafted with Socket Graft
Histology of a site grafted with Socket Graft showing remarkable proliferation and migration of osteoblasts with mineralization

FAQ

Bone augmentation involves adding material to build up the jawbone, while regeneration stimulates natural bone growth that results in healthy normal tissue.

Bone grafting is often necessary in cases of severe bone loss or when immediate implants are placed after tooth extraction.

Yes, though a socket that is healed with no graft at all is not as healthy or as vital as normal bone.

What are your options?

  • Ask your dentist about using our products for your procedure
  • Contact us to find a dentist near you who uses our products
  • Contact us to schedule a consultation with Dr. Steiner in Roseville, CA

MEMBER:

American Society for Bone and Mineral Research (ASBMR)

Tissue Engineering and Regenerative Medicine International Society (TERMIS)

American Academy of Implant Dentistry (AAID)