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Bone Grafting

If a person has any missing teeth, over time the jawbone that is associated with these will atrophy/ will be reabsorbed.  In most cases, this condition leaves insufficient amount of bone. Even if there is bone mass, the quality may not be up to the mark to support a dental implant. 

In situations such as these, the patients cannot be candidates for dental implant placement. But the type of surgery that we perform at our clinic allows us to place implants that are of the appropriate width and length and we are able to restore functionality & esthetic appearance. 

Major Bone Grafting

The bone grafting procedure is used to repair the implant sites that have an insufficient amount of bone structure on account of injuries, gum disease and extractions. The bone could be obtained either from a tissue bank/ bone from your jaw may be taken. In some cases a part of the tibia or hip bone may be used. We also perform sinus bone grafts to replace bone that is in the posterior upper-jaw.

Apart from this addition, special membranes may also be used. These membranes dissolve just under the gum, protect the bone graft & encourage bone regeneration. This procedure is called guided bone-regeneration/guided tissue regeneration. Typically, major bone grafts are performed to repair certain jaws defects. These defects could be a result of tumor surgery, traumatic injuries or congenital defects.

The large defects are all repaired with the use of the patient’s bone. This bone will be harvested from a different sites based on the defect-size. The common donor sites are- skull (cranium), lateral knee (tibia) and hip (iliac crest).These procedures are very routinely-performed in an operating room & the patient will be required to stay at the hospital for them.

Sinus Lift Procedure

The maxillary sinuses lie just behind your cheeks & above the upper teeth. Sinuses are somewhat like empty rooms and have nothing in them. Some roots of natural upper-teeth extend right up into these maxillary sinuses. Whenever the upper teeth are removed, there is generally a very thin separating wall of bone between the maxillary sinus & the mouth. Dental implants require bone support to hold them in position.

In cases where the sinus wall is extremely thin, it becomes impossible to place implants in this particular bone. These procedures could be performed separately/together, based on the patient’s condition.

As mentioned earlier, there are a number of areas of the body which are suitable for getting bone grafts. When it comes to the maxillofacial region, these bone grafts can also be taken from the mouth, (chin area/third molar region/ upper jaw just behind the last teeth). In more severe situations, a larger bone mass can be acquired from the hip/ the tibia’s outer aspect, at the knee. Whenever the patient’s bone is used for repairs, we tend to get the best results.

Other Methods

In a number of cases, we can also use allograft material in the implementing bone grafting for the dental implants. This particular bone is made from cadavers & used to promote growth of the patient’s own bone, into that repair site. This is a very effective and safe procedure. It is also possible to use synthetic materials to stimulate bone formation. All these surgeries can be performed in an out-office surgical suite & under IV sedation. Once the patient has been discharged, it is recommended that he/she take bed rest for a day and limit physical activity for at least a week.

The sinus graft/sinus lift graft is the solution. The dental implant surgeon will enter the sinus from the space where the upper teeth used to be positioned. Once the sinus membrane has been lifted upwards, the donor bone will be inserted in the sinus floor. It must be understood that the sinus floor is actually the upper jaw’s roof.  It takes several months for the bone to heal; but after that this graft will become a part of the jaw bone. It will then be possible to insert dental implants in the new sinus bone.

Years ago, most patients had to wear loose dentures and there was no other option, but sinus grafting has changed all that. If there is a sufficient amount of bone in-between the upper jaw ridge & the lower part of the sinus, to support the implant properly, sinus augmentations& implant placement may sometimes be performed in a single procedure. If there is insufficient bone, this Sinus Augmentation procedure will have to carried out first. Once the graft has matured for several months, based on the kind of material that was used in it, the implants can then be placed in it.

Nerve-repositioning

The inferior-alveolar nerve gives feeling to the chin & lower lip. This might have to be moved to make room for dental implants placement in the lower jaw. This particular procedure is only limited to the lower-jaw & is indicated whenever there are missing teeth in the area of the 2 back molars and/or the 2nd premolar, with the secondary condition mentioned above.

This particular procedure is considered to be very aggressive approach (as there is postoperative numbness in the jaw & lower lip area, that takes long to dissipates, if ever). This is the reason why other, less-aggressive options are generally considered first.

We generally remove the outer section of the cheek-side from the lower jawbone, to expose the nerve & the vessel canal. We then isolate the nerve & vessel bundle in the area, & pull it out slightly to the side. The implants will be positioned at the same time. The bundle is then released & replaced over the implants. The surgical access will then be refilled with the bone-graft material that the surgeon has decided to use & the area is then closed.

As mentioned earlier, there are a number of areas of the body which are suitable for getting bone grafts. When it comes to the maxillofacial region, these bone grafts can also be taken from the mouth, (chin area/third molar region/ upper jaw just behind the last teeth). In more severe situations, a larger bone mass can be acquired from the hip/ the tibia’s outer aspect, at the knee. Whenever the patient’s bone is used for repairs, we tend to get the best results.

Allograft Material

In a number of cases, we can also use allograft material in the implementing bone grafting for the dental implants. This particular bone is made from cadavers & used to promote growth of the patient’s own bone, into that repair site. This is a very effective and safe procedure. It is also possible to use synthetic materials to stimulate bone formation.

All these surgeries can be performed in an out-office surgical suite & under IV sedation. Once the patient has been discharged, it is recommended that he/she take bed rest for a day and limit physical activity for at least a week.