Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. 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 esthetic 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.
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 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 and matured 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 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.
"We even use factors from your own blood to accelerate and promote bone formation in graft areas."
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.
These surgeries are performed in the out-office surgical suite under IV sedation. After discharge, bed rest is recommended for one day and limited physical activity for one week.
How to Prepare for the Procedure
If you are scheduled to undergo a bone grafting procedure, it is important to take steps to prepare for the procedure and maximize your chances of a successful outcome. Below are some of the key steps you can take to prepare for a bone grafting procedure:
Understand the Procedure
Before undergoing a bone grafting procedure for the teeth and jaw, it is important to have a clear understanding of the procedure and what it involves. Your surgeon should explain the procedure in detail, including the risks and benefits, and answer any questions you may have.
Get a Comprehensive Evaluation
To ensure that you are a good candidate for a bone grafting procedure for the teeth and jaw, you will need to undergo a comprehensive evaluation that includes a physical exam, dental exam, and imaging studies such as X-rays and CT scans. Your surgeon may also recommend additional tests or consultations with other specialists as needed.
Address Any Pre-Existing Conditions
If you have any pre-existing medical or dental conditions, it is important to address these before undergoing a bone grafting procedure for the teeth and jaw. This may include treating gum disease, getting any necessary dental work done, or managing chronic health conditions such as diabetes or hypertension.
Follow Pre-Operative Instructions
Your surgeon will provide you with detailed instructions to follow in the days and weeks leading up to your procedure. This may include dietary restrictions, medication adjustments, and other preparations to ensure that you are in the best possible health for the procedure.
Prepare for the Recovery Process
A bone grafting procedure for the teeth and jaw requires a recovery period, during which you may experience pain, swelling, and other side effects. It is important to prepare for this by arranging for time off work or school, lining up support from family and friends, and making any necessary adjustments to your living space to accommodate your recovery needs. You may also need to modify your diet during the recovery period to ensure that you are getting the nutrients you need to promote healing.
Arrange for Transportation
Depending on the type of anesthesia used during the procedure, you may need to arrange for transportation to and from the surgical center. Talk to your surgeon about the type of anesthesia that will be used and make arrangements accordingly.
Inform Your Surgeon of Any Medications
It is important to inform your surgeon of any medications you are taking, including prescription medications, over-the-counter medications, and supplements. Your surgeon may recommend that you stop taking certain medications before the procedure to reduce the risk of complications.
Plan for Post-Operative Care
After the bone grafting procedure, you will need to take steps to promote healing and reduce the risk of complications. This may include taking prescribed medications, following a soft food diet, practicing good oral hygiene, and attending follow-up appointments with your surgeon.
Finally, it is important to ask any questions or raise any concerns you may have before undergoing a bone grafting procedure for the teeth and jaw. Your surgeon should be happy to answer your questions and provide you with the information you need to make an informed decision.
Possible Risk and Complications and How to Avoid Them
While bone grafting is relatively safe and effective, there are some risks and complications that can occur. These include:
- Infection. Infection is a potential risk with any surgical procedure. To minimize the risk of infection, it is important to follow your surgeon's post-operative instructions carefully, including keeping the surgical site clean and avoiding activities that could introduce bacteria into the area.
- Bleeding. Bleeding is a common side effect of bone grafting. To minimize the risk of bleeding, avoid smoking, using straws, or engaging in any activities that could put pressure on the surgical site.
- Pain and Discomfort. Pain and discomfort are common after bone grafting. Your surgeon will prescribe pain medication to help manage your symptoms. It is important to take this medication as directed and to avoid overexerting yourself during the recovery period.
- Nerve Damage. Nerve damage is a rare but serious complication of bone grafting. To minimize the risk of nerve damage, choose a skilled and experienced surgeon, and inform your surgeon of any pre-existing nerve conditions.
- Rejection. In some cases, the body may reject the bone graft, leading to complications. To minimize the risk of rejection, your surgeon will carefully screen you to ensure that you are a good candidate for the procedure.
- Graft Failure. In rare cases, the bone graft may fail to integrate with the surrounding bone tissue. To minimize the risk of graft failure, follow your surgeon's post-operative instructions carefully, and attend all follow-up appointments.
To avoid these risks and complications associated with bone grafting, it is important to choose a skilled and experienced surgeon who specializes in this type of procedure. Follow your surgeon's pre-operative and post-operative instructions carefully, and inform your surgeon of any pre-existing medical or dental conditions that may increase your risk of complications.
In addition, make sure you attend all follow-up appointments, and contact your surgeon immediately if you experience any symptoms of infection or other complications. With proper care and attention, you can minimize the risk of complications and enjoy a successful outcome after bone grafting.
Additionally, there are some steps you can take to help promote healing and reduce the risk of complications after a bone grafting procedure. These include:
- Practice Good Oral Hygiene. Maintaining good oral hygiene is essential after a bone grafting procedure. This includes brushing and flossing regularly, as well as using an antiseptic mouthwash to help prevent infection.
- Follow a Soft Food Diet. Eating soft, nutritious foods can help to promote healing and reduce the risk of complications after a bone grafting procedure. Avoid hard, crunchy, or spicy foods that could irritate the surgical site.
- Avoid Smoking. Smoking can interfere with the healing process and increase the risk of complications after a bone grafting procedure. If you smoke, it is important to quit before the procedure and avoid smoking during the recovery period.
- Avoid Strenuous Activities. Strenuous activities can put pressure on the surgical site and interfere with the healing process. Avoid activities such as heavy lifting or exercise for several weeks after the procedure.
- Attend Follow-Up Appointments. Attending follow-up appointments with your surgeon is essential to monitor your progress and detect any potential complications early on. Be sure to attend all scheduled appointments and notify your surgeon of any concerns or symptoms you may be experiencing.