When teeth are lost prematurely, for whatever reason, the upper and lower jawbones will atrophy or deteriorate in these affected areas. This often leaves a situation in which there is an inadequate quality and/or quantity of bone suitable to place, stabilize and maintain dental implants. In these situations, many patients will require bone grafting to create an adequate volume of bone before dental implants can be placed.
Today, we have the ability to grow bone where needed. We refer to this as bone preservation grafting and bone augmentation grafting. This not only gives us the opportunity to place implants of proper length and width where needed, it also gives us a chance to restore jaw function where it had previously been lost and at the same time improve the patient’s esthetic appearance.
Bone grafting can repair potential implant sites with inadequate bone volume due to previous extractions, gum disease or injuries. The bone can either be obtained from the patient, or much more frequently, is a combination of a particulate human allograft (cadaver) mixed with a biologic product (see PRGF below), or recombinant bone protein (see Infuse Bone Graft below) that induces the production of your own bone.
Bone Preservation Grafting
Whenever a patient has to lose a tooth, one of the ways commonly used to replace the lost tooth is a dental implant. This will act as an artificial tooth root, on top of which a tooth crown can be placed. From a surgical point of view, a dental implant requires an adequate volume of bony height, width and length to place and primarily stabilize the dental implant. In certain cases, extraction of the tooth and surgical placement of the dental implant can be performed at the same time, as long as there is enough bone to hold the implant without any mobility. Because this is not always possible, Bone Preservation Grafting is often times performed simultaneously with the tooth extraction. This is the best way to ensure there will be an adequate volume of bone to place and stabilize an implant at a later time. It is a relatively easy procedure that involves filling the extraction socket defect with bone graft material and covering the area with a membrane to contain the graft material long enough for the adjacent soft tissue to grow over this area.
Bone Augmentation Grafting
When an upper or lower jaw bone has had teeth missing for an extended period of time, significant resorption, or loss of bony volume, can occur. These situations lead to a thin, horizontal bony ridge that has an inadequate amount of horizontal bony width to place, stabilize and maintain dental implants. In these situations, bone augmentation grafting is necessary. This consists of augmenting or adding bone graft material to the horizontally deficient site to make up what has been lost in the way of bony width. These grafts are sometimes supported by titanium “tenting screws” and are usually covered by some type of dissolvable membrane. The membrane aids in containing the bone graft where it was placed, as well as separating the blood supply from the overlying soft tissue. After several months, the membranes dissolve and by this time, the bone grafts have incorporated, or become part of the jawbone they were added to. A confirmation x-ray is usually taken to ensure the bone graft has adequately healed before the patient is scheduled to return for surgical placement of a dental implant/s.
Sinus Lift Bone Graft Procedure
The maxillary sinuses are air filled spaces behind your cheeks and on top of the upper teeth. 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 too thin, it is impossible to place dental implants in this bone.
The solution to the aforementioned problem is called a sinus lift and bone graft procedure. The oral surgeon enters the bottom portion of the sinus in the region where the upper teeth were previously lost. The sinus membrane is then carefully lifted upward and a bone graft 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 graft becomes part of the patient’s upper jaw and dental implants can be surgically inserted and stabilized in this new 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 exists between the upper jaw ridge and the bottom of the sinus to stabilize an implant without mobility, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus graft 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.
Infuse Bone Graft
In 2007, the FDA approved Infuse Bone Graft for two Oral and Maxillofacial Surgical indications. This product has been used since 2002 for bone grafting procedures involving spinal fusions, open tibia fractures and now, oral surgery. Infuse Bone Graft is recombinant human bone morphogeneic protein (rhBMP2) which is a synthetically produced naturally occurring protein that stimulates a patient’s stem cells to convert into bone forming cells. Dr. Hochberg and Dr. Abel can use this product for bone grafting in conjunction with Maxillary Sinus Lift procedures and localized augmentation of deficient bony ridges that are to receive dental implants. For more information regarding the possible use of this bone grafting product, please contact our office.