Major & Minor Bone Grafting
As a result of gum disease, injuries, or tooth extractions, the portion of jawbone that is affected may begin to deteriorate, making the site unsuitable for placement of dental implants. In this situation, bone grafting is necessary. Fortunately, modern science has provided a way to grow bone where it is needed. Through this process of grafting, the oral surgeon can make repairs that allow the patient to have dental implants.
Bone is either obtained from a tissue bank or is taken from the patient’s own jaw or skull, hip, or tibia. Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be used. These membranes dissolve under the gum and protect the bone graft as well as encourage regeneration. This method is called guided bone regeneration or guided tissue regeneration.
For major defects of the jaw, such as those that are congenital or those resulting from traumatic injuries or from tumor surgery, the dental surgeon uses the patient’s own bone. This major procedure is routinely performed in an operating room, and requires a hospital stay.
Sinus Lift Procedure
The maxillary sinuses are behind the cheeks and on top of the upper teeth. Sinuses are like empty rooms. 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.
The solution involves a sinus graft or sinus lift graft. The oral surgeon accesses the sinus through the space where the upper teeth were located. The sinus membrane is the lifted and donor bone is inserted into the floor or the sinus, which also serves as 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.
If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant, sinus augmentations and implant placement can be performed as a single procedure. If the required amount of bone is not available, the sinus augmentation will have to be performed first. Then the graft will have to mature for several months, depending on the type of graft material used. Once the graft has matured, the implants can be placed.
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 a few months ahead of implant placement.
Again, 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 obtained from the hip or the outer aspect of the tibia at the knee. Generally, the best results are achieved when the patient’s own bone is used for repairs.
In many cases, allograft material is used 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.
These surgeries are performed in the office surgical suite under IV sedation or general anesthesia. After discharge, the patient is instructed to have bed rest for one day and to limit physical activity for one week.