Ridge Augmentation
in Honolulu, HI
 Ridge augmentation is a bone grafting procedure that rebuilds the width or height of the alveolar ridge, the part of the jawbone that holds your teeth, when there is not enough bone to support a dental implant.
At Pacific Maxillofacial Center, our board-certified oral and maxillofacial surgeons perform ridge augmentation at our Honolulu and Waipi’o offices, most often as a planned step before dental implant placement in patients whose existing bone volume is too low for implants alone.
This procedure is one of several procedures within the bone grafting family. It differs from socket preservation, which is a small graft placed in an extraction socket at the time the tooth is removed. Ridge augmentation is typically performed weeks, months, or years after a tooth has been lost, once the alveolar ridge has already shrunk. It is also separate from a sinus lift, which adds bone height specifically below the maxillary sinus, though the two procedures are sometimes combined in the upper back jaw.
If your dentist has told you that you do not have enough bone for an implant, ridge augmentation is one of the most common ways to rebuild the foundation that dental implants need. This page explains how the procedure works at our office, what to expect during healing, and how the timing fits with implant placement.
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What Is Ridge Augmentation?
 The alveolar ridge is the section of jawbone that originally held your tooth roots. After a tooth is lost and not replaced, the ridge gradually loses both width and height because the bone no longer gets the stimulation that the tooth root used to provide. The longer the area goes without a tooth, the more bone is lost. Periodontal disease, traumatic injury, and certain congenital conditions can also create the same kind of deficiency.
Ridge augmentation rebuilds that lost bone using a graft. There are two main types of ridge defects, and most cases involve one or both:
- Horizontal ridge defect – The ridge has become too narrow side-to-side. The graft adds width so an implant of normal diameter can be placed.
- Vertical ridge defect – The ridge has become too short top-to-bottom. The graft adds height so an implant of normal length can be placed.
Depending on the size and shape of the defect, we use one of two grafting approaches. For smaller defects, we use particulate graft material covered by a protective membrane (a technique called guided bone regeneration). For larger defects, we may use a block graft, where we shape a piece of donor or synthetic bone to fit the deficient area and secure it in place. Both approaches rely on the same biological principle: the graft material acts as a scaffold for your own bone to grow into.
When Ridge Augmentation Is Needed
Ridge augmentation is not needed for every implant case. The decision is based on the bone volume already present at the implant site, which we measure using CBCT imaging at the consultation.
Patients who typically need ridge augmentation fall into one or more of these categories:
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Long-term tooth loss – Those who have been missing a tooth for several years often have measurable bone loss at the site
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Periodontal disease before extraction – Bone loss from gum disease can occur even before the tooth is removed
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Extraction without socket preservation – Sockets that healed without a graft typically lose the most width and height
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Naturally thin ridges – Some patients have a thin alveolar ridge by anatomy rather than by tooth loss |
In some cases, we perform a sinus lift in the upper back jaw during the same surgical visit as a horizontal or vertical ridge augmentation. Combining procedures avoids a second surgical visit and a separate healing period.
Patients who already have adequate bone do not need ridge augmentation. Bone volume is one factor in the broader dental implant candidacy evaluation we conduct at the consultation.
Your Oral Surgery Team in Honolulu
Pacific Maxillofacial Center was founded in 1999 by Dr. Todd K. Haruki, who completed 12 years of graduate and post-graduate surgical training, including a hospital-based oral and maxillofacial surgery residency at the University of Louisville. He is a Diplomate of the American Board of Oral and Maxillofacial Surgery and a Fellow of the American Dental Society of Anesthesiology.
Dr. Neil Oishi holds DDS and MD degrees from the University of Southern California and the University of Florida College of Medicine respectively, and completed his oral and maxillofacial surgery residency at the University of Florida. He is also a Diplomate of the American Board of Oral and Maxillofacial Surgery, a Member of the International Team of Implantology, and serves as an on-call facial trauma surgeon at Queen’s Medical Center.
The dual DDS-MD training matters for ridge augmentation specifically because larger augmentation cases involve precise tissue handling, accurate placement of block grafts when used, and coordination with implant planning months ahead of placement. Both Dr. Haruki and Dr. Oishi regularly handle ridge augmentation cases as part of the practice’s implant-focused workflow.
The Ridge Augmentation Procedure, Step by Step
 Most ridge augmentation cases follow the same structural sequence, though the surgical time and healing period vary with the size of the defect.
Step 1: Consultation and CBCT Planning
At your consultation, we take a CBCT scan of the implant site. The scan shows the size and shape of the bone deficiency in three dimensions, which determines the grafting approach. We also discuss whether the case is best done as a standalone ridge augmentation, combined with a sinus lift, or staged in another way.
Step 2: Surgical Visit
On surgery day, we numb the area with local anesthesia, administer your chosen sedation, and proceed with the grafting. The sedation options range from local anesthesia for smaller cases to IV sedation or general anesthesia for larger augmentations. We make a small incision in the gum tissue over the deficient area. Depending on the case, we place either particulate graft material with a protective membrane or a block graft shaped to fit the defect. We close the area with sutures and send you home with detailed post-op instructions.
Step 3: Healing Period
Ridge augmentation requires a longer healing period than smaller grafts. Most cases need 4 to 9 months for the graft to fully integrate with your existing bone, with larger augmentations on the longer end of that range. During this period, your body remodels the graft material into dense bone capable of anchoring an implant. CBCT imaging at the end of the healing period confirms the new bone volume before we plan implant placement.
Step 4: Implant Placement
Once your bone is ready, the next step is dental implant placement following our standard protocol. The implant goes into the rebuilt ridge, and from there, the treatment timeline matches a typical implant case rather than a staged graft-then-implant case. Some patients choose computer-guided implant placement for the implant phase, which uses the planning CBCT and a 3D-printed surgical guide for precise positioning in the augmented site.
Benefits of Ridge Augmentation
For patients who have been told they do not have enough bone for a dental implant, ridge augmentation reopens the door to a treatment that previously was not possible. Several benefits compound at our office because the same team plans and performs both the graft and the eventual implant.
The primary benefit is restored eligibility for a dental implant. CBCT scans at the consultation tell us exactly how much bone is missing and where, and the same imaging at the end of healing confirms the rebuilt volume before we move forward. That measurement-driven approach means we are not guessing about whether the augmented site can support an implant.
Continuity of care matters for ridge augmentation because the months-long gap between graft and implant placement is part of the treatment, not a separate appointment with a new provider. Because our office performs both the graft and the implant, the surgeon who placed your graft is the same surgeon reading the healing CBCT and planning the implant position. The original surgical plan and imaging stay in our system throughout.
In-office anesthesia at both our Honolulu and Waipi’o offices means the sedation plan for ridge augmentation does not require coordinating with an outside anesthesiologist. Dr. Haruki’s ADSA Fellowship covers the deeper sedation that larger augmentations commonly call for, so the surgical and anesthesia plans stay with one team.
Once integrated, the augmented bone behaves like your original bone. An implant placed into a successfully augmented ridge has comparable expected longevity to an implant placed into native bone, provided the augmentation healed properly. We confirm that healing with CBCT before placing the implant, which gives the patient and the surgeon shared confidence in the foundation.
Why Choose Our Practice for Ridge Augmentation
Our two-office structure on Oahu means patients in Honolulu and the West Oahu corridor can both reach a board-certified oral surgeon without a long drive. The Honolulu office is at 1060 Young St #312, and the Waipi’o office is at 94-1221 Ka Uka Blvd #B-204 in Waipahu.
CBCT imaging from our dental technology stack carries through the entire ridge augmentation timeline. At the consultation, the scan defines the bone defect in 3D. At the surgical visit, the same scan informs the graft placement. At the end of healing, repeat CBCT confirms the rebuilt volume before implant placement.
Because our office handles the augmentation, the healing assessment, and the eventual implant, the entire treatment stays with one team across the months-long timeline. There is no handoff between a general dentist and a separate specialist for the implant phase. Dr. Oishi’s membership in the International Team of Implantology brings additional implant-focused training to the planning phase.
Dr. Haruki’s ADSA Fellowship and both surgeons’ MD-level training mean ridge augmentation can be done under whichever sedation level fits the case. Smaller augmentations are often comfortable with local anesthesia and oral sedation, while larger cases use IV sedation or general anesthesia administered and monitored in-house.
Ridge Augmentation Cost and Insurance
Cost matters, and ridge augmentation pricing varies more than many dental procedures because the size of the defect and the grafting approach can range widely. A small horizontal augmentation using particulate graft and a membrane is priced differently than a large vertical augmentation using a block graft. CBCT imaging and the sedation level you choose also factor in.
Dental insurance coverage varies. Some plans cover ridge augmentation when it is documented as part of an implant treatment plan; others classify it as a separate elective procedure not covered by the dental benefit. Medical insurance generally does not contribute to ridge augmentation costs. Our front office staff verifies benefits before treatment, and our insurance and financing section covers payment options for any remaining patient responsibility.
Call our Honolulu office at 808-585-8455 if you want benefits checked before scheduling.
Schedule Your Consultation
Ridge augmentation starts with a CBCT consultation. The visit confirms the diagnosis and shapes the plan to implant placement. Call our Honolulu office at 808-585-8455 or request an appointment online. Our Honolulu office is at 1060 Young St #312, Honolulu, HI 96814. We also see patients at our Waipi’o office. The Contact page is the easiest way to reach us in writing.
Frequently Asked Questions
How do I know if I need ridge augmentation?
The CBCT scan at your consultation answers this question definitively. The scan measures the width and height of bone at the implant site in three dimensions. If the measurements fall below the threshold required for safe implant placement, ridge augmentation is needed. Your dentist may have already raised the concern based on 2D X-rays, but the CBCT scan at our office is what confirms the diagnosis.
Can I just get the implant without ridge augmentation?
In most cases, no. Implants require a minimum amount of bone width and height to be placed safely. Attempting to place an implant in an inadequate ridge increases the risk of implant failure, nerve injury, or sinus complications. In some cases, a narrower or shorter implant can be used instead of augmentation, but the decision depends on the specific anatomy at the implant site.
Is ridge augmentation a separate surgery from the implant?
Yes. Ridge augmentation is a planned grafting procedure that takes place months before the implant is placed. The graft needs 4 to 9 months to integrate with your existing bone before an implant can be anchored into the rebuilt site. The two procedures cannot be safely combined in the same appointment for most cases.
Will the procedure hurt?
The area is fully numbed with local anesthesia, and IV sedation or general anesthesia from our sedation options is available for larger cases. Most patients have limited memory of the procedure itself. Post-op discomfort and swelling are typical for the first 3 to 5 days and respond to the pain control we send home. Larger block grafts can produce more discomfort than smaller particulate grafts because of the additional surgical exposure.
How long until I can get my implant?
The graft typically integrates over 4 to 9 months. CBCT imaging at the end of the healing period confirms the rebuilt bone volume before we move to implant placement. Smaller horizontal augmentations are usually on the shorter end of that range; larger vertical or block-graft cases are on the longer end.
What graft material is used?
Several materials work for ridge augmentation, including processed donor bone (allograft), animal-derived material (xenograft), and synthetic alternatives (alloplast). For larger defects, autograft (bone from your own body) is sometimes used. The choice depends on the specific case, the surgeon’s preference, and the structural needs of the site. We discuss the material being used as part of the consent process before the procedure.
What if the graft does not take?
Graft failure is uncommon when the procedure is properly planned and the patient follows the post-op instructions. When a graft does not integrate successfully, the most common cause is infection or excessive load on the area during healing. If a graft fails, we evaluate the cause, allow the site to heal, and plan a revision graft. The implant timeline is delayed in those cases, but the path forward is usually still implant restoration.
Does insurance cover ridge augmentation?
Coverage varies. Some dental plans cover ridge augmentation when documented as part of an implant treatment plan; others classify it as a separate elective procedure not covered by the dental benefit. Medical insurance generally does not contribute. Our front office staff verifies your specific dental benefits before treatment, and the insurance and financing section covers payment options for any remaining responsibility. |
