Major & Minor Bone Grafting
After a period of time, the jawbone that is associated with missing teeth atrophies or is reabsorbed. This will often leave the jawbone in a condition in which there is poor quality and quantity of bone that is suitable for placement dental implants. In situations similar to these most patients will not be suitable candidates for the surgical placement of dental implants.
With recent technology we now have the ability to grow bone where it is needed. This technique not only gives up the chance to place dental implants of the correct length and width, but it also gives us an opportunity to restore the functionality and aesthetic appearance.
Major Bone Grafting
Bone grafting can give us the opportunity to repair implant sites with inadequate bone structure due to past extractions, gum disease or injuries. Sinus bone grafts can also be performed to replace bone in the posterior upper jawbone. In addition, certain special membranes can be used that dissolve below the gum and protect the bone graft and promote bone regeneration. This technique is called guided bone regeneration or guided tissue regeneration.
Major bone grafts are commonly performed to repair defects of the jawbone, upper and lower. These defects can arise as a result of traumatic injuries, congenital defects, or tumor surgery. Larger defects many times are repaired using the patient’s own bone. This bone can be acquired from a variety of different sources depending on the size of the defect. The skull (cranium), lateral knee (tibia), and hip (iliac crest) are the most typical donor locations. These surgeries are regularly performed in an operating room and require a hospital stay.
Sinus Lift Procedure
The maxillary sinuses are located behind the cheeks and on top of the upper teeth. Sinuses are similar to an empty room that has nothing in it. Some roots of the natural upper teeth can extend up into the maxillary sinuses. After removal of the upper teeth occurs, there is usually a thin sheet of bone separating the maxillary sinus and the mouth.
If implants are needed a "sinus lift" with associated bone augmentation may be performed.
The surgeon enters the sinus from the previous location of the upper teeth. The sinus membrane will then be lifted upward and the donor bone is then inserted into the lower part of the sinus or the top of the roof of the upper jaw. After a period of healing has occurred the bone permanently becomes part of the jaw then the implants may be placed and stabilized in the new sinus bone.
The sinus graft makes it acceptable for many people to have dental implants.
When there is an abundance of bone between the upper jaw ridge and the bottom of the sinus floor, sinus augmentation and dental implants may be completed in a single surgery. When there is a lack of available bone, the sinus augmentation will need to be performed first. The bone graft will have to heal and mature. Once the graft has matured, the dental implants may be placed.
In certain cases where the patients ridge is thin expansion may be needed. This technique is used when it is needed to restore lost bone dimension when the jaw ridge becomes inadequate to insert standard implants. In this procedure, the bony ridge of the jaw is expanded by mechanical means and grafted with bone.
The inferior alveolar nerve, which supplies us with feeling to the lower lip and chin, may sometimes need to be moved to make space for the insertion of dental implants in the lower jaw. This procedure is only performed on the lower jaw and indicated when the teeth are missing in the location of the two posterior molars and/or second premolar, with the above mentioned secondary condition. However, this procedure is thought to be a highly aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates very slowly, if ever). Therefore less aggressive alternatives are considered first (insertion of blade implants, etc.).
Commonly, it is an outer section of the cheek side of the lower jawbone that is removed so the nerve and the vessel canal can be exposed. The nerve and the vessel bundle are isolated and slightly pulled out to the side. At that time, the implants will be inserted. Then the bundle is released and relocated back to its original location over the implants. The surgical access is refilled with bone graft material and the location is sealed.
These procedures can be performed together or separately, depending on the patient’s condition. As stated earlier, there can be several various locations on the body that are suitable for obtaining bone grafts. In the maxillofacial region, bone grafts may be taken from the inside of the mouth, in the location of the chin or the third molar region, or in the upper jaw located behind behind the last tooth. In more extensive situations a larger quantity of bone may be obtained from the outer aspect of the tibia at the knee or the hip.
In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to promote the patients own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.
These surgeries are performed in the out-office surgical suite under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.