Major & Minor Bone Grafting
Over a period of time, the jawbone associated with missing teeth atrophies or is resorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and aesthetic appearance.
Major Bone Grafting
Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee). Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.
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.
In severe cases, the ridge has been resorbed 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 allowed to mature for a few months before placing the implant.
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 in the lower jaw. This procedure is limited to the lower jaw and sometimes indicated when teeth are missing in the area of the two back molars and/or second premolar. This procedure poses a greater risk of postoperative numbness of the lower lip and jaw, which dissipates only very slowly and may result in permanent partial or complete numbness. Other alternatives may be considered first.
Typically, an outer section of the cheek side of the lower jawbone is removed in order to expose the nerve. 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 nerve is released and gently placed back over the implants. The surgical access is refilled with bone graft material 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 obtaining living bone grafts (autografts). In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or wisdom tooth 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. When we use the patient’s own bone for repairs, we generally get the best results.
In many cases, we can use human bone (allograft) material to replace or augment dental implant sites. This bone is tested and prepared from cadavers and is very effective to promote the patient’s own bone to grow into the repair site. It is quite safe and nearly equally as good as the patient’s own living bone. Synthetic materials (alloplasts) can also be used to stimulate bone formation and are equally as effective. We even use factors from your own blood (PRP; BMP) to accelerate and promote bone formation in graft areas. The advantage of using allografts or alloplasts is that the patient does not have to undergo additional surgical procedures to obtain bone, which usually means shorter surgical time and less risk for post-operative discomfort, swelling, and infection.
These surgeries are typically performed in the in-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.