Bone Grafting

View our jaw surgery multimedia presentation:
> Bonegrafting minimodule

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 and may disrupt the normal facial contours. 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. Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease, pathology or injuries. The bone can be obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia. In some instances synthetic bone substitutes can be used alone or in conjunction with natural bone. In addition, special membranes may be utilized that dissolve under the gums and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.

Major Bone Grafting

Major bone grafts are typically performed to repair large 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 by our surgeons in an operating room and require a hospital stay.

Minor Bone Grafting

Minor bone grafts may be needed to help augment or improve an implant site. Grafting of this nature is often performed in conjunction with the placement of an implant and may consist of synthetic bone or small amounts of bone harvested from another location in the mouth. These are most commonly used to improve the stability and esthetics of an implant and generally are performed in the office.

Sinus lift procedure

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 or replacing missing teeth with a bridge.

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like rooms that have nothing in them and are simply lined with mucosal tissue. 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 bone graft or “sinus lift”. Your surgeon enters the sinus through a small window. The sinus membrane, or lining, 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. Occasionally the graft and an implant can be placed during the same procedure allowing them to heal at the same time. Your surgeon will be able to advise you on what is possible for you based on your comprehensive evaluation.

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 is a nerve that courses through the lower jaw and gives feeling to the lower lip and chin. This nerve may need to be moved in order to make room for the placement of dental implants in the lower jaw. This procedure is indicated when teeth are missing in the area of the molars and/or premolars and not enough bone remains above the nerve. Since this procedure has additional risks (potential postoperative numbness of the lower lip and jaw area), less aggressive options are generally considered first.

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 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 can then be refilled with bone graft material of the surgeon’s choice and the area closed.

These procedures are performed in our in-office surgical suite under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for up to one week.

Pre-prosthetic Surgery

The preparation of your mouth before the placement of a prosthesis is referred to as pre-prosthetic surgery.

Some patients require minor oral surgical procedures before receiving a partial or complete denture, in order to ensure the maximum level of comfort. A denture sits on the bone ridge, so it is very important that the bone is the proper shape and size. If a tooth needs to be extracted, the underlying bone might be left sharp and uneven. For the best fit of a denture, the bone might need to be smoothed out or reshaped. Occasionally, excess bone would need to be removed prior to denture insertion.

One or more of the following procedures might need to be performed in order to prepare your mouth for a denture:

• bone smoothing and reshaping (alveolplasty)
• removal of excess bone
• bone ridge reduction
• removal of excess gum tissue
• exposure of impacted teeth

We will review your particular needs with you during your appointment.