Bone Grafting

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Bone Graft

Bone Graft

Major & Minor Bone Grafting

After some time, the jawbone in an area of the mouth with missing teeth becomes atrophied or is reabsorbed (resorption). This can often create a condition where there is either poor quality of bone, or a lack of quantity of bone for the viable placement of dental implants. Where these situations exist, the affected patients, for the most part, are not candidates for the placement of dental implants.

With modern technology and medical breakthroughs, we have the ability to actually grow bone back where it is needed. This not only makes it possible to then place implants of the proper length and width, but it also makes it possible to restore proper functionality, as well as restore the natural, aesthetic appearance of your face, jaw, and teeth.

Major Bone Grafting

Bone grafting makes it possible to repair implant sites that have inadequate bone structure due to either previous extractions, damage from gum disease, or other injuries. The bone used in grafting is obtained from an allograft (a tissue graft from a donor of the same species as the recipient but not genetically identical), a tissue bank, or even from your own jaw, hip, or tibia (the large bone right below the knee.) More often than not, an allograft is used in order to spur new bone growth. An allograft mixes natural collagen and minerals with a bone structure of allograft to help increase new bone formation and structure. Bone grafts performed on sinuses are also done to replace bone. In this case, the bone is in the posterior upper jaw. Additionally, we may use special membranes that dissolve underneath the gum, protecting the bone graft and spurring more bone regeneration.

Sinus Lift Procedure

The maxillary sinuses are located behind your cheeks, and above the upper teeth. Sinuses are simply an empty space, like a room with nothing in them. Sometimes the roots of our natural upper teeth can extend into these maxillary sinuses. When these upper teeth get removed, there’s usually just a very thin wall of bone that separates the maxillary sinus and the rest of the mouth. Dental implants require bone to keep them in place and hold them. Where the wall of the sinus is thin, it’s not possible to place a dental implant into it. The solution to this issue is what is known as a sinus lift, or a sinus lift graft.

The dental implant surgeon, or oral surgeon enters the sinus from the area where the upper teeth once were. The membrane of the sinus is then actually lifted upward, and the donor bone is then placed into the floor of the sinus. Remember, the floor of the sinus also acts as the roof of the upper jaw. After several months of allowing the area to heal, the “new” bone incorporates into the patient’s jaw, becoming part of it, at which time the dental implants can then be inserted and stabilized in this new sinus bone.

Sinus grafting makes dental implants possible for many patients even when years ago there wasn’t an option available to them, other than wearing loose dentures.

If there is enough bone between the upper jaw ridge and the bottom part of the sinus, and it’s sufficient enough to stabilize the implant well, sinus augmentations and implant placement can sometimes be done as a single procedure. If there isn’t enough bone available, the sinus augmentation has to be done first, then the graft will need to mature over several months, depending on the type of material used for grafting. When the graft has matured sufficiently, the implants can then be placed.

Ridge Expansion

In the more severe cases, the ridge of the jawbone has been reabsorbed and a bone graft needs to be placed in order to either heighten or widen it. This type of bone grafting is done to restore the lost dimensions of the bone when the jaw’s ridge gets too narrow to place a regular implant. For this procedure, the bony jaw ridge is, quite literally, expanded mechanically. Bone grafting material can be placed and allowed to mature for several months before the implant is placed.

Nerve Repositioning

There are instances where a nerve needs to be moved in order to make more room for placing a dental implant in the lower jaw. This nerve is called the inferior alveolar nerve, and it’s the nerve that gives feeling to the lower lip and the chin. This procedure is only limited to the lower jaw and is indicated when teeth are missing from the area of the two back molars, and/or second premolar, with the aforementioned secondary condition. This procedure is considered to be a very aggressive approach, however (there’s almost invariably some sort of postoperative numbness in the lower lip and jaw, which goes away very slowly, if ever), and it’s because of this usually other, and less aggressive options, are considered first (like the placement of blade implants, etc.).

Usually, a part of the outer section of the cheek side of the lower jawbone is taken out to expose the nerve and the vessel canal. After doing this, we isolate the nerve and the bundle of vessels in the area, and just slightly pull it out to the side. At the same time, we will place the dental implants. The bundle of vessels is then released, and it’s put back over the implants. The surgical access area is then filled with bone grafting material, chosen by the surgeon, and the area is then closed.

The procedures mentioned may either be performed separately or together. It all depends on the individual’s condition. As was mentioned earlier, there are multiple parts of the body that are eligible for attaining bone for a bone graft from. In the maxillofacial area, bone grafts can be acquired from inside the mouth, in the region of the chin or third molar, or in the upper jaw in the area behind the last tooth. In the more extensive and involved situations, you would need a great amount of bone, and this can be acquired from the hip or the outer side of the tibia at the knee. Using the patient’s own bone for repairs usually will yield better results overall.

In a lot of cases, we can use allograft material in order to implement bone grafting for dental implants. This bone material is taken from cadavers and it is used with the purpose of promoting the patient’s own bone to fill in the repair site. It’s quite an effective and safe option. Synthetic materials may be used as well, in order to stimulate the formation of bone. We even use factors from your very own blood to speed up and spur bone formation in the graft areas.

The surgeries outlined above, are performed in our state-of-the-art surgical suite, under IV sedation or general anesthesia. After discharge, we recommend bed rest for at least one day, and a limit to physical activity for a week.

For more information on how we can help bring back your full and natural looking smile, and to schedule a FREE consultation, give us a call at (202) 296-6600 today. We look forward to hearing from you!


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