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Bone Grafting

Major and Minor Bone Grafting

Over a period of time, a jawbone that is missing teeth shrinks, atrophies, or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone which is unsuitable for placement of dental implants. In these situations, most patients may not be candidates for placement of dental implants. However, almost anyone could be a candidate for implants by improving the bone structure in the area where the implant is needed.

Today, we have the ability to add 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.

Types of Bone Available

There are different sources of bone used to augment jawbones to prepare for implants. In many cases banked bone or synthetic bone substitutes may be used.  However for larger, more extensive areas, a bone graft from another part of the body  may be recommended.

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 performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum to 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 larger defects of the jaws. These defects may arise as a result of traumatic injuries,  previous tumor surgery, or congenital defects. Large defects are  typically 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 short hospital stay.

Sinus Lift Procedure

The maxillary sinuses are behind your cheeks and above the upper teeth. Sinuses are hollow, empty air filled spaces. 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 area due to the lack of bone.

There is a solution and it's called a sinus graft or sinus lift graft. The surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted onto the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. This adds more bone in the area of the missing molar teeth.  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 bone.

The sinus graft makes it possible for many patients to have dental implants who previously were not candidates for implants and had to settle for wearing 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 is performed first, and then the graft matures for several months. Once the graft has matured, the implants can then be placed.

Ridge Expansion

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.

Nerve-Repositioning

The inferior alveolar nerve, which gives feeling to the lower lip and chin, can 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 1st and 2nd premolars, when there is not enough bone above the nerve to fit an implant. Other procedures, such as bone grafting are usually considered as first option. However if grafting is not possible nerve repositioning may be considered to facilitate implant placement.

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