Why Do I Need a Bone Graft?
The loss of alveolar bone volume can occur before dental extraction due to periodontal disease, periapical pathology, and trauma to the teeth and bone. Additionally, the traumatic removal of teeth can cause bone loss and must, therefore, be prevented. In addition, the alveolar bone suffers atrophy after tooth extraction. The resorption and remodeling of the alveolar ridge after tooth removal is a natural healing phenomenon and can negatively impact implant placement. To meet the requirements of prosthetically-guided implant placement, the remaining alveolar ridge must, therefore, be restored in most of the cases.
Bone grafting helps increase the volume and shape of the jaw bone available to place a dental implant. An adequate amount of healthy bone to support a dental implant is required as Inadequate bone support increases the chances of implant failure and undesirable treatment outcomes. Bone grafting is a surgical procedure that can usually be done in the dental office. It replaces the bone that has been lost with material from the patient's own body (autogenous bone) or with a natural, artificial, or synthetic substitute. The goal is to generate new healthy and natural bone in the area of the procedure. Such grafting replaces missing bone lost from previous dental extractions, injuries, accidents, cysts, periodontal disease, infections along with many other causes. In most instances, the entire graft may be made up of synthetic or animal bone. This is commonly done where the amount of bone that needs to be augmented is small. In small volume bone grafting, the synthetic bone occupies the space needed for the new bone to grow in and as the new bone is formed, the synthetic material gradually dissolves away.
If you lose one or more permanent teeth, an indention may result in the gums and jawbone where the tooth used to be. When no longer holding a tooth in place, the jawbone recedes and the resulting indentation looks unnatural. Ridge augmentation is a procedure that can recapture the natural contour of the gums and jaw. A new tooth can then be created that is natural looking and complements your smile.
Tooth loss causes the jawbone to recede and can lead to an unnatural looking indentation in your gums and jaw, an appearance of a general aging. The original look of your mouth may not be recaptured because of spaces remaining under and between replacement teeth. They may appear too long compared to nearby teeth.
At Portland Perio Implant Center we routinely see patients that require various types of ridge augmentation for implant placement as well as pre-prosthetic correction of defects. We always use the latest techniques and materials to achieve optimal outcomes. With advances in both surgical techniques and understanding of healing processes as well as the use of regenerative biologic agents, healing times may be shorter and procedures less invasive. It is very common that combination procedures are performed simultaneously if indicated. These scenarios allow for placement of the dental implant and bone graft to be performed in one visit which in turn reduces the healing time, discomfort and cost of therapy.
The outcome of treatment with implants is no longer measured exclusively in terms of implant survival, but also by the long-term esthetic and functional success of the prosthesis. The successful esthetic and functional restoration of an implant depends on its optimal placement, which is influenced by the jaw bone dimensions. Because the ridge dimensions are so crucial, it is advantageous to preserve the dimension of the post-extraction ridge instead of reconstructing it thereafter, thus maintaining its ideal vertical and horizontal dimensions and decreasing patient morbidity.
Socket preservation is a procedure in which graft material or scaffold is placed in the socket of an extracted tooth at the time of extraction to preserve the alveolar ridge. The aim is to minimize bone shrinkage, and therefore preserving the ridge width to allow a more optimal outcome for a future denture, bridge or implant. After extraction, jaw bones may need to be preserved to keep sockets in their original shape. A significant reduction of the alveolar ridge in the horizontal dimension occurs if the socket does not receive some type of treatment.
The bone filling of the socket can be significantly improved with preservation techniques. Without socket preservation, the bone quickly resorbs. The jaw bone will never revert to its original shape once bone is lost and tissue contour has changed. Bone grafting following tooth loss can preserve the socket/ridge and minimize gum and bone collapse. There is less shrinkage and a more aesthetic tooth replacement for either an implant crown or fixed bridge around the replacement teeth.
Case study coming soon: Removal of infected tooth and socket preservation with bone graft in preparation for future implant placement.
Sinus Grafting (Elevation/Lift)
Above the roots of the molars and premolars are the maxillary sinuses that essentially are empty spaces within bone, lined by a layer of tissue which secretes mucous. The mucous helps to humidify the air as it enters through the nose on the way to the lungs. These cells lining also contain hairlike structures that function like a broom, sweeping the mucous and any foreign particles that is trapped in the mucous, out of the sinus and into the nose where they are discharged.
When these upper teeth are removed there is both shrinkage of the socket and remodeling of the jaw bone as well as expansion of the sinus cavity into the space once occupied by the tooth (pneumatization). This natural healing process often results in a reduced vertical height of bone required for implant placement. Dental implants need bone to hold them in place so when the sinus wall is very thin, it is to place dental implants in this bone.
For implants in the back part of the upper jaw, the bone deficiency is often at the tip of the implant and bone graft is often added there via a procedure known as a sinus lift. The dental implant surgeon enters the sinus either from the side above where the upper teeth used to be (Direct Approach) or vertically through the jaw bone from below (Indirect Approach) - See Example below. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Remember, the floor of the sinus is the roof of the posterior upper jaw bone. 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 timing of placement of the implant there depends on the amount and quality of bone engaged by the implant near the top of the implant instead of the tip. Implants can often be placed simultaneously at the time of the sinus lift procedure as long as an adequate amount of bone is present to engage and stabilize a portion of the implant length. The healing of the bone graft and implant integration takes place together. If not, then it is prudent to wait a few months before insertion of implant.
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.
Prior to sinus grafting a 3D image of the sinuses are obtained to exclude the presence of pathology and visualize the space in greater detail for diagnostic and planning purposes.
Ridge Grafting, also known as Ridge Augmentation, is a procedure that can recapture the natural contour of the gums and jaw. If you lose one or more permanent teeth, an indention may result in the gums and jawbone where the tooth used to be. When no longer holding a tooth in place, the jawbone recedes and the resulting indentation looks unnatural. After ridge grafting is done, a new tooth can then be created that is natural looking and complements your smile.
Bone Ring Grafting Technique
Portland Perio Implant Center is the first location in Oregon to offer this technique for simultaneous bone augmentation and implant placement.
Although this method aims to simplify, shorten treatment length and make implant placement possible in areas which normally require staged bone grafting with a minimum of 6 months healing period, it is a technically advanced technique that requires surgical expertise in the field of bone augmentation and implant therapy.
Implant restoration in the edentulous jaw often requires additional augmentation measures on account of the physiological remodeling and resorption processes following tooth loss and the associated reduction in bone availability. This grafting technique has been successfully used for bone augmentation in sinus lift procedures, large ridge defects as well as challenging vertical ridge grafting in the posterior arches.
This method eliminates many of the problems associated with autogenous grafting. Since bone used for autologous grafts is usually obtained from intraoral donor regions, little autologous bone is available for augmentation. Other disadvantages are that the additional intraoral bone harvesting procedure is stressful for the patient and can increase the risk of potential postoperative complications at the donor site, including pain, infection and altered sensation.
Unlike the current method of harvesting intraoral bone in block form, the bone ring is a simple possibility of obtaining Allograft donor bone in ring form and performing reconstruction of three-dimensional defects. This procedure enables a one-stage minimally invasive procedure for a bone graft to be combined with simultaneous implant insertion in large defects. This translates to less patient stress and greater patient acceptance. By means of the bone ring method, primarily stable implant insertion is achievable in a one-stage procedure even when local bone availability is low.