Jawbone Augmentation: Reconstructive Bone Grafting
Mandibular Bone Loss Severe Example
The Basics of Bone Grafts
The science of bone augmentation in dentistry and all of its intricacies usually becomes a topic of intense interest to older adults.
Catastrophic Bone Loss Gum Disease
Poor Oral Health Habits Excessive Untreated Extractions
Multiple loss of teeth and the increasing incidence of gingivitis and periodontitis is somewhat cumulative and affects older populations rather than younger.
Unusual conditions can occur at younger ages that might be associated with birth defects (missing incisors – a common disorder), inadequate orthodontic treatments, developmentally malformed upper and lower jaw relationships, the classic cleft palate ….. and perhaps the most common … untreated tooth extractions that can create the need for a bone graft procedure.
The Graft Procedure No One Gets
Theoretically … all of us, who have had an extraction here… an extraction there.. starting around those ages where adult teeth are being removed (usually for convenience or financial reasons) may be setting the stage for future bone loss issues that we don’t focus on until later years.
Socket grafts are perhaps one of the simplest bone graft treatments that researchers recommend for common and seemingly simple adult tooth extraction. More and more research shows that untreated extractions will initiate bone loss in the immediate extraction site but can threaten adjacent bone supporting other nearby teeth.
Common Grafting Procedures
Reconstructive dentists whose practices are heavily focused on a variety of tooth replacement technologies typically have a variety of hard tissue (bone) augmentation products that can successfully treat individual areas or larger expanses of a jawbone arch.
The jawbone graft type and the procedure used for a particular graft treatment is determined by the location of depleted bone, amount lost and the remaining tissue health. Like many other complex dental treatments… there is no “one size fits all” concept.
Types of Bone Grafting Materials
Provided by the patient, self donated. It can be harvested from the lower jaw, or lower leg. Although autogenous grafts are considered the “gold standard” of grafting, it involves an additional surgical site. Grafts from the lower jaw are popular and successfully provides more bone for the dental implant.
Bone products that are derived from humans and provided in the form of sterile and deproteinated demineralized freeze dried bone. Combined with Platelet Rich Plasma (PRP) these materials serve as an excellent graft for sinus lifts and ridge-splitting techniques. These products are used in massive quantities in medicine and dentistry with great success. Common applications include various bone grafting procedures after a tooth is extracted or to grow more bone for dental implant placement.
Derived from non human species like a cow and are readily available. Compounds for stimulating or accelerating tissue regeneration are often combined with these grafting materials. This material is commonly used in ridge splitting surgeries to regenerate width of bone and in sinus bone grafts.
Artificial synthetic bone material that can be made of glass or ceramics. Not used as often as other products mentioned above. Present long term research does not demonstrate useful application of synthetic bone material.
Membranes are commonly used in many hard tissue graft surgeries. Because of the different regenerative properties of hard and soft tissues, they are used to prevent soft tissue from growing into or migrating into the graft material before the bone has a chance to regenerate.
Nonresorbable membranes offer the feature of being able to remain in the graft site for a longer period of time (increases predictability of success) but require an additional surgery to remove the product when it is no longer needed.
Resorbable membranes are probably the most popular and conveniently dissolve by themselves after a few months. There is no residual of the product to remove.
The effects of age and missing teeth will cause the bottom of the sinus cavity to enlarge. A sinus lift or sinus bone graft will move the bottom of the sinus border back to the original position. Grafting materials are moved into the site, which later heals into increased bone height between the sinus cavity and bone area of the planned implant device. Various procedures exist to gain bone height within the sinus. A 3-D image of the bone determines which procedure is most suitable.
Visit our “Solutions For No Bone” page to learn more about Dr. Brant’s use of this advanced bone modification procedure that restores hope for patients who have been told they have no bone left.
Thin ridges that exist on either jawbone, as a result of long term denture use or an extended history of multiple untreated tooth extractions, can be treated with grafting procedures that creates space within the existing bone. Specialized grafting products can then be injected or manually packed into the area of interest with great accuracy.
Specialized tools are used to create the necessary space for bone graft material. This can be a very effective way to widen the jawbone before implant placement. After healing is completed.. the grafted sites can be prepared for the final implant devices.
Dr. Brant has been performing ridge splitting procedures since 1997. In fact, Dr. Brant has lectured to other surgeons at local and national meetings on how to perform ridge splitting techniques.
Block grafting is an immensely popular procedure for patients who have had extreme bone loss and are fortunate to find a skilled and experienced surgeon, periodontist or implantologist who implements the procedures routinely and confidently.
Block grafts are reserved for severely deficient implant sites. Healthy bone that best match the tissue structures of the patient’s existing jawbone have the greatest statistical advantage of healing and functioning in a near text-book fashion. Most of the time, a small segment of bone is removed from the lower wisdom tooth area. The bone grows back in the area within a short time so there is no lasting structural change to the lower jaw. The small segment of bone is secured where it is needed the most.
Since the cellular structure is a near perfect match, osseointegration and the overall progression of reconstruction and eventual placement of implant teeth replacements is uneventful.
Since relatively few dentists have the training and experience to provide block grafting as an option, it is not uncommon for patients who are in need of block grafting option… not be offered this option.
Denture patients in particular need to be aware that bone grafting options are almost always available that can restore the cumulative lost dental function due to years and years of denture use.
The Need for Bone Graft Surgery: Summary
- Preventing / controlling the loss of jawbone after tooth extraction (Socket Regeneration Grafting/Ridge Preservation)
- Augmenting the jawbone in preparation for the installation of prosthesis (fixed bridge, implant supported denture)
- Replacing bone lost to periodontal or gum disease (periodontitis rehabilitation)
- Bone voids associated with implant placement
- Replacement of bone lost due to denture use
Patients seeking additional information or details about specialized treatment sessions or appointments are invited to contact Dr. Brant directly via our on-line Ask The Dentist form during or after usual business hours.