A Front Tooth Lost to a Childhood Injury, Rebuilt with a Block Graft, and How It Is Done Today

Before After

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The Situation

A central incisor knocked out in childhood. When a tooth is lost in childhood, the bone that held it tends not to develop as it otherwise would, and the ridge narrows further over the years. By the time this patient was ready for an implant, the ridge was about one millimeter wide. An implant needs several millimeters of bone around it, and in the smile line the shape of that bone decides how natural the gum looks.

What Was Done

A block of the patient’s own bone was taken from elsewhere in the jaw, fixed to the thin ridge with small screws, and packed around with particulate graft, then covered and left to heal for several months. Once the ridge was wide enough, an implant was placed and later restored with a crown by the patient’s dentist. Bone grafting explains when a graft is needed and what recovery is like.

The Result

The photograph shows the site before treatment and the finished implant crown. A tooth in the smile line that matches its neighbors, on a ridge rebuilt to carry it. This is among the most demanding situations in implant dentistry, because the gum contour has to be rebuilt along with the bone.

How a Ridge Like This Is Rebuilt Today

This case was treated with a block graft. Dr. Verrett no longer harvests bone blocks. A ridge like this one is now rebuilt with a particulate graft: bone granules packed against the ridge under a resorbable collagen membrane, planned on a 3D scan. The membrane is held still with the Ribroast Technique™, a row of sutures anchored in the tissue over the bone. The research behind that change:

• Particulate grafts gain comparable width in thin ridges. In knife-edge ridges much like this one, Urban and colleagues gained 5.56 millimeters of width with no complications in 22 patients. A second series gained 5.68 millimeters, with one complication in 31 sites. Across studies, Troeltzsch and colleagues found particulate grafts added 3.7 millimeters of width on average, about a millimeter less than blocks, which is enough for most implant sites.
• They gain more height, with fewer complications. In a 2019 meta-analysis for the European Workshop on Periodontology, Urban, Montero, Monje and Sanz-Sánchez found particulate grafting gained 4.18 millimeters of height with complications in 12.1 percent of cases. Bone blocks gained 3.46 millimeters, with complications in 23.9 percent.
• There is no second surgical site. A block has to be cut from the chin or the back of the jaw. After chin harvesting, almost half of patients in Raghoebar’s follow-up reported decreased sensation in the chin one to three years later. A review by Nkenke and Neukam found chin harvesting caused enough pain and sensory change that patients preferred bone from the hip.
• Unprotected blocks shrink. Mandibular blocks lost 23.5 percent of their added width and 42 percent of their added height before implant placement in Cordaro’s series. Chin and hip blocks lost 35 to 51 percent of their volume in the first year in a CT study by Sbordone and colleagues. Blocks hold their shape much better when covered with particulate mineral and a membrane: in a ten-year study by Chappuis and colleagues, covered blocks lost 7.7 percent. Today’s block technique depends on the same granules and membrane that particulate grafting uses on its own.
• Stability is what makes particulate grafting work. In a laboratory study by Mir-Mari and colleagues, closing the gum over a loose particulate graft pushed in 43 percent of its thickness at the top, against 23 percent when the membrane was fixed. Membrane exposure cut the width gained by 74 percent in a meta-analysis by Garcia and colleagues. A stabilized membrane and a tension-free closure address both.
• The field has moved the same way. The consensus report of the 2019 European Workshop on Periodontology, by Jepsen and colleagues, found rebuilding ridge width predictable with either approach and complication rates high with every method, which favors the approach with one surgical site. In a bibliometric analysis of 4,386 papers on ridge augmentation published since 1990, Hu and colleagues found guided bone regeneration with particulate grafts was the most extensively studied technique. Blocks are still used, particularly by oral surgeons: 73 percent of German oral and maxillofacial surgeons surveyed in 2025 by Pabst and colleagues reported using them.

Block graft or particulate ridge augmentation? sets out the full evidence, including grafting at the same visit as the implant and the alternatives to bone from the hip. Bone grafting for dental implants describes how ridges are rebuilt in this office and what recovery is like. If you have been told you need a block graft, a second opinion can compare the options for your ridge.