Major & Minor Bone Grafting
Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance. Just as importantly jaw ridge bone can be maintained by grafting extraction sites at the time of tooth removal. This is the best way to insure adequate bone for future implants. Socket grafting adds no increase in postoperative discomfort or surgical time.
Major Bone Grafting
Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee.) Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of he defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.
Sinus lift procedure
The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.
There is a solution and it’s called a sinus graft or sinus lift graft. Drs. Bagnoli, Steffey or Dragoo enter the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.
The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.
If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
Ridge-augmentation with Onlay Grafting
In severe cases where the tooth supporting ridge has been reabsorbed a bone graft is placed to increase the ridge width and/or height. In these situations, the graft is taken from another area inside your mouth and transplanted into the deficient area. Once transplanted, it will grow in its new location. This in-office procedure is usually performed using sedative or general anesthesia and takes about an hour.
The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants to the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the back molars and/or and 2nd premolar. The nerve is isolated through a window in the bone. It is brought laterally, out of the way. At the same time the implants are placed and the nerve bundle is released and placed back over the implants. This procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever), therefore other, less aggressive options are considered first.
There are several areas of the body that are suitable for attaining bone grafts. Most commonly bone needed for implant site preparation can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. These more complex grafting cases are performed in a hospital or surgery center setting. In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to get the patients own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be sued to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.