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Bone Grafting

Bone grafting is the replacement of supporting bone around the teeth which has been lost. It is also known as bone augmentation or ridge augmentation.
Today, bone grafting procedures have become almost an integral part of implant reconstruction. In many instances, a potential implant site in the upper or lower jaw does not offer enough bone volume or quantity to accommodate a Rootform Implant of proper size or in the proper place. This is usually a result of bone resorption that has taken place since one or more teeth (if not all) were lost. Bone Grafting procedures usually try to re-establish bone dimension, which was lost due to bone resorption.





Although your surgeon often knows in advance when a graft will be necessary, at times this is only discovered when the implant site is opened during surgery and he is prepared to replace the necessary bone.

Sinus Lift

Sinus is the term given to anatomical cavities that exist within our body. There is one in the region of the cheek bone that is termed the Maxillary Sinus.
Our upper teeth especially the back ones often have their roots dipping into or in close proximity to the maxillary sinus. The natural response to tooth loss is shrinkage in the amount of bone existing around the tooth that was there, this means that if an upper tooth is lost there is a decrease in the height of bone beneath the sinus. In such a situation if the patient wants Implants it becomes impossible to insert the implant in such a diminished height of bone, thereby necessitating such a procedure that would restore the bone height.

This procedure is what we term as a sinus-lift. It is a very specialized procedure carried out under strict asepsis. Implants may be inserted at the same stage or at a later date depending on the situation.





Situations that might necessitate that a sinus lift be performed before a tooth implant can be placed.

There can be several reasons why the amount of bone found in the patient's upper jawbone might be insufficient to accommodate a dental implant. Some of them include:

  1. The relative size and shape of an individual's upper jaw as well as the current size and shape of their maxillary sinus (the size of the sinus can change with age) varies among people. While over simplified, any one person may have a combination of a relatively small upper jaw and relatively large sinus which together create a situation where there is an insufficient amount of bone for the placement of a tooth implant.
  2. The patient has experienced bone loss due to gum disease.
  3. Bone resorption associated with previous tooth extractions. - The magnitude of post tooth extraction bone loss can be as much as 40 to 60 percent within the first three years after teeth have been removed. Beyond that point, the rate of bone loss typically subsides substantially. The cause of post extraction bone resorption is typically attributed to disuse atrophy, decreased blood supply, localized inflammation and/or unfavorable pressure from a dental appliance (denture or partial denture).
  4. Bone loss due to other factors.- In some cases a bone deficiency may be associated with a previous surgical procedure such as a difficult tooth extraction or the removal of a cyst or tumor.

Dental implants have gained popularity for treating patients with no teeth , but some of these patients develop jaw atrophy, which leaves insufficient bone for implants. To treat these patients, the sinus lift procedure, which augments bone, was developed. Altered anatomy from this procedure has an unusual radiographic appearance, confusing those unfamiliar with it. We describe the sinus lift procedure and its radiographic appearance.

Block Bone Grafting

In severe cases the ridge has been reabsorbed and a bone graft is placed to increase the ridge height and/or width. In these situations, the graft is taken from another area inside your mouth or body. This dental implant bone grafting technique is where a block of bone is cut out of one area and screwed into the area where the dental implants will be placed. Normally, the block bone graft is placed and allowed to integrate into the jaw bone for four to six months before the dental implant is placed. This office procedure is usually performed using general anesthesia and takes about an hour. These procedures may be performed separately or together, depending upon the individual's condition. There are several areas of the body which are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. 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.



Bone 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 dental 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 dental 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. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever), usually other, less aggressive options are considered first (placement of blade implants, etc.)

Typically, we remove an outer section of the cheek side of 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 will place the implants. 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.

These procedures may be performed separately or together, depending upon the individual's condition. As stated earlier, there are several areas of the body that are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. When we use the patient’s own bone for repairs, we generally get the best results.

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.

Guided Tissue Regeneration

Soft tissue, such as gum tissue, grows very fast while bone grows very slow. When a surgical hole is created by a surgeon, soft tissue grows into the surgical hole very quickly and blocks out bone from growing into the hole. When bone is needed in an area to place dental implants, uncontrolled gum tissue growth is a problem. A membrane barrier can be used to cover the surgical hole and block out the gum tissue from growing into the area. This allows the more slowly growing bone to fill the surgical hole without any competition.

The membrane barrier guides the gum tissue away from the surgical defect. Gums and bone are both tissues and both are guided by the artful placement of a membrane barrier. Because the bone regenerates in the surgical hole, the technique is called guided tissue regeneration. Some surgeons call it guided bone regeneration because implant surgeons are very concerned about the supporting bone around their dental implants. Guided tissue regeneration can be used to repair defects around previously placed dental implants or to create additional bone in deficient areas before placing dental implants. The surgical hole can be filled with several different types of materials before covering the area with a protective membrane barrier.

Ridge Modification

Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. This defect may have been caused by periodontal disease, wearing dentures, developmental defects, injury or trauma. Not only does this deformity cause problems in placing the implant, it can also cause an unattractive indentation in the jaw line near the missing teeth that may be difficult to clean and maintain.

To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Your periodontist can tell you about your options for graft materials, which can help to regenerate lost bone and tissue.
Finally, the incision is closed and healing is allowed to take place. Depending on your individual needs, the bone usually will be allowed to develop for about four to 12 months before implants can be placed. In some cases, the implant can be placed at the same time the ridge is modified.
Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come. Ridge modification can enhance your restorative success both esthetically and functionally.

Types of Bone Grafting Materials

With respect to the Bone Graft material used, we have to differentiate between several choices. All materials can be categorized into five different categories:

  • Autograft or autogenous bone graft
  • Allograft or allogenic bone graft
  • Xenograft or xenogenic bone graft
  • Alloplast or alloplastic bone graft
  • Growth Factors


Each of the bone graft materials is usually developed with a specific purpose or advantage in mind. Your surgeon will make a decision with respect to the bonegraft material, based on your individual needs and the latest research in that field.

Healing Period after Bone Grafting

The healing period required after a bone graft ranges between three and nine months, depending on the individual case. The implant can be placed once the graft is completely healed. In some cases, implant placement and bone grafting can be done at the same time.

Please contact us to setup a consultation for a checkup.