Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there are poor quality and quantity of bone suitable for placement of dental implants. In the past, many of these patients were 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, but 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, or injuries. The bone is usually obtained from a tissue bank or your own bone is taken from various parts of your jaw. 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.
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 bone. This bone is harvested from a number of different sites depending on the size of the defect. In most cases, we add “PRP” to the harvested bone to accelerate the rate of bone growth. PRP is “PLATELET RICH PLASMA” which is blood collected from the patient on the day of surgery.
Sinus Lift Procedure
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. Dr. Habekost enters the sinus, then the sinus membrane is lifted upward and bone particles are placed 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, tiny cuts are made in the jaw to facilitate movement, using an ultrasonic bone saw. Then 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.
In addition to the types of bone grafts detailed above, there are other ways to grow bone where we want it. A common technique to accomplish this is to make tiny slices in the existing bone (again using an ultrasonic bone saw to keep the slices as small as 0.3mm wide) and then placing a bone distractor (a tiny stainless steel screw/plate). In this procedure, since no movement is done at the time of surgery, post-op discomfort is typically minimal. After healing for a week, the sutures are removed, and the patient is instructed how to use a driver to move the bone 1mm per day, in much the same way as orthodontic expanders have been used for years. The bone can be moved in any direction we need it to move, and movement is typically complete in less than 2 weeks. No bone graft material is needed or used with this technique! After an additional healing interval, the distractor is removed and the implants can then be placed.