Bone Graft

Major & Minor Bone Grafting

Over a period of time, the jawbone associated with missing teeth disintegrates or is eventually reabsorbed. Often times, this will leave people with a condition in which there is a reduced quality and quantity of bone that is acceptable for the placement of dental implants. In these situations, most patients are not the ideal candidates for the placement of dental implants.

The technology we have today allows us to have the ability to grow bone where it’s necessary. Not only does this give us the opportunity to place the proper length and width of implants but it also gives us a chance to bring back functionality and the aesthetic appearance.

Major Bone Grafting

Bone grafting can repair implant sites with an insufficient bone structure that have been caused by previous extractions, gum disease or other injuries. The bone is either obtained from your jaw, hip or tibia (below the knee), or is taken from a tissue bank. Sinus bone grafts are also performed to replace bone in the posterior upper jaw. Additionally, special membranes may also be utilized that will dissolve under the gum, protect the bone graft and also encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.

Major bone grafts are commonly performed to repair the defects of the jaws. These defects may arise as a result of traumatic injuries, congenital defects or  tumor surgery. Large defects can be repaired by using the patient’s own bone that can be taken from a number of different areas depending on the specific size of the defect. Common donor sites are the skull (cranium), hip (iliac crest), and lateral knee (tibia). Since these procedures are frequently performed in an operating room, they will typically require an inpatient hospital stay.

Sinus Lift Procedure

The maxillary sinuses are located behind your cheeks and on top of the upper teeth. Sinuses are similar to empty rooms. A portion of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, often times there is just a thin wall of bone that is separating the maxillary sinus and the mouth. Dental implants will need bone in order to successfully hold them in place. When the sinus wall is very thin, it is extremely difficult to place dental implants in this bone.

The solution to this problem is called a sinus graft or a sinus lift graft. During this particular procedure, the dental implant surgeon enters the sinus from where the upper teeth used to be located. The sinus membrane is then lifted upward and the donor bone can then be inserted into the floor of the sinus. Remember that the floor of the sinus is also the roof of the upper jaw. Once this procedure is performed, and after several months of healing, the bone will then become part of the patient’s jaw and dental implants can then be successfully added and stabilized into this new sinus bone.

This particular sinus graft procedure makes it possible for many patients to have dental implants, unlike several years ago when there was no other solution to the problem other than wearing loose dentures.

If there is enough bone in between the upper jaw ridge and the bottom of the sinus in order to stabilize the implant successfully, then sinus augmentations and implant placement can sometimes be performed as a single procedure. If there isn’t enough bone available, then the sinus augmentation procedure will have to be performed initially. Depending on the type of graft material used, the graft may have to mature for several months. Then the implants can be placed once the graft has been matured.

New techniques using ultrasonic scalpels (piezoelectric) are now being used to allow surgical access, which minimizes the risk of cutting the sinus membrane.

Ridge Expansion

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

Nerve Repositioning

The inferior alveolar nerve, which is responsible for giving 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 is determined when the teeth are missing in the area of the two back molars and/or the second premolar, with the above-mentioned secondary condition. Since this particular procedure is considered a very aggressive approach (since there is usually some postoperative numbness of the lower lip and jaw area, which dissipates very slowly, if ever), usually other, less aggressive options are considered first.  New techniques using ultrasonic scalpels (piezoelectric) allow surgical access minimizing risk of cutting the inferior alveolar nerve.

Frequently, an outer section of the cheek side of the lower jawbone is removed in order to expose the nerve and vessel canal. We then isolate the nerve and vessel bundle in that area and slightly pull it out to the side. It is at this time that we will place the implants. Then the bundle is released and placed back over the implants. The surgical access is then 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 particular 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 the third molar region, or in the upper jaw behind the last tooth. In more extreme situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. We generally get the best results when using actual bone from the patient themselves.

In several cases, we can use allograft material to implement bone grafting for dental implants. This bone is used to promote the patients own bone to grow into the repair site. Doing this is safe, and quite effective. 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.

These surgeries are performed in the out-office surgical suite under IV sedation or general anesthesia. After you are discharged, we recommend bed rest and limited physical activity for one week.