Bone Grafting

Major & Minor Bone Grafting

When teeth are prematurely lost, the jawbone associated with the missing teeth atrophies or is reabsorbed over time. This often leaves a condition in which there is poor quality and quantity of bone suitable for the placement of dental implants. In these situations, many patients are not candidates for the placement of dental implants.

Today, we have the ability to grow bone where it is 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.

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone can be either synthetic or animal bone, obtained from a tissue bank, or your own bone can be taken from your jaw, hip or tibia (below the knee.) Sinus bone grafts are also performed to replace bone in the back of the 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.

 

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Sinus Lift Procedure

The maxillary sinuses are found above the teeth in the back of your upper jaw. Sinuses are empty air filled cavities. Some of the roots of the natural upper teeth extend 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. Additionally, bone loss from periodontal (gum) disease and the effect of the body’s natural healing process (called pneumatization) causes less bone in the area. 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.

One solution to this problem is a procedure called a sinus graft or sinus lift graft. The oral and maxillofacial surgeon enters the sinus from the area where the upper teeth used to be. The sinus membrane is then gently lifted upward and bone is inserted into the bottom of the sinus. The bottom of the sinus is the top of the upper jaw. By adding bone to the bottom of the sinus, the surgeon is adding vertical height to the upper jaw. After several months of healing, the bone graft material becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new bone. If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize an implant well, sinus grafting and implant placement can sometimes be performed as a single procedure.

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.

Block Bone Grafts from Inside the Mouth

Occasionally, when the bone is deficient in width in the area that is planned for a dental implant, a block bone graft procedure is necessary to add bone to the area for additional width. The bone for these grafts is typically taken from areas within the mouth; either the chin or the back area of the lower jaw. These procedures require an incision in a separate surgical site, inside the mouth, in order to obtain the bone grafts. No external deformity of your jaw or face will be obvious once the area heals. This procedure is usually performed in the office. Your doctor will explain the procedure and the anesthesia options to you at length at your consultation appointment.

Ridge Expansion

In some cases, if the ridge has been resorbed and is deficient in width, a procedure can be performed to expand the bony ridge surgically. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants.

This procedure involves making small bony cuts in the area of the jawbone that requires widening and stretching the bone to increase the area in width. Bone graft material may be placed as well and allowed to mature for a few months before placing implants. This procedure is usually performed in the office under IV sedation or general anesthesia. Your doctor will explain the procedure and the anesthesia options to you at length at your consultation appointment.

Alveolar Ridge Distraction

If the jaw ridge is deficient in height, a procedure to lengthen and stretch the ridge can be performed in order to increase the bone in height. This procedure involves making small bony cuts in the area to be lengthened, placing a distractor device on the bone, and slowly stretching the bone over a few days. With this slow stretching, new bone will be generated that will fill the gap. Three months after the procedure, a small office procedure is performed to remove the distractor device. Patients do not experience significant pain from this procedure. A CAT Scan prior to the procedure may be necessary for planning. These procedures can be performed in the office or hospital. Your doctor will explain the procedure and the anesthesia options to you at length at your consultation appointment.

Nerve-Repositioning

The Inferior Alveolar Nerve is the nerve which gives feeling to the lower lip and chin. Although rarely recommended, this nerve can be moved in order to make room for the placement of dental implants in the lower jaw. Usually other less aggressive options are considered first. The risks and benefits of this and other surgical options will be discussed with you at length by your doctor.

Major Bone Grafting

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 can be harvested from a number of different sites depending on the size of the 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.