Bone Grafting

When teeth are missing in the upper or lower jaw bone, a degenerative process happens in the bone. This process is called atrophy. Bone can resorb and leave a condition where there is poor quantity and quality of bone which is unsuitable for the placement of dental implants. In the past, this problem could prevent patients from having reconstruction via dental implant technique. However, today we have the ability to graft bone in order to increase the bone quantity to allow implant placement in these circumstances. This provides the opportunity to place implants of proper length and width, as well as restore function and aesthetics.

Minor Bone Grafting

When small defects exist, a procedure called Regeneration surgery can be utilized. This involves the use of a bone substitute, such as Bio-os or Puros in conjunction with a specialized membrane (covering). The bone substitute and the covering membrane are re-absorbed over time and the body deposits or regenerates new bone in the area.

Regeneration Surgery techniques are available for:

RIDGE PRESERVATION AFTER DENTAL EXTRACTIONS.
PERIODONTAL DEFECTS AROUND NATURAL TEETH AND IMPLANTS.
BONE DEFECTS ASSOCIATED WITH ENDODONTIC ( ROOT CANAL ) SURGERY PROCEDURES - CALLED APICOECTOMIES.
LARGE ORAL CYST / PATHOLOGY.

Major Bone Grafting

Larger bone defects sometimes require that bone be replaced with the patient's own bone. This is called autogenous bone. These larger defects can arise secondary to traumatic injuries, tumor surgery, congenital defects, or losing teeth very early in one's life.

The autogenous bone can be harvested from different sites in the body, depending upon how much volume of bone is required to correct the defect. For smaller defects, intraoral sites, such as the chin region or the wisdom tooth areas can be utilized. This can be coordinated with an in office procedure and intravenous anesthesia.

For larger defects, donor sites can be utilized from the hip (iliac crest) or from the lateral knee region (tibia). These procedures are performed in hospital under general anesthesia.

For a brief narrated overview of the Bone Grafting process, please click the image on the right. It will launch our flash educational MiniModule in a separate window that may answer some of your questions about Bone Grafting.

Sinus Lift Procedure

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. 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 very thin, it is impossible to place dental implants in this bone.

There is a solution and it’s called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone 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 becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus 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 between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation 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.

Ridge Expansion

In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.

Nerve - Repositioning

The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants to the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and 2nd premolar, with the above-mentioned secondary condition.

Typically, a small bony window is created in the lower jawbone in order to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area, and slightly pull it out to the side. At the same time we place the implants we’ll be tracking the neuro-vascular bundle. Then the bundle is released and placed back over the implants. The surgical access is refilled with bone graft material of the surgeon’s choice and the area is closed.