Bone Grafting Greenbrae CA
Bone grafting is a procedure that is typically performed in preparation for or in conjunction with dental implant placement. When a dental implant is planned to restore a missing tooth or teeth, the sites must be evaluated for the presence of an adequate volume of bone in all three dimensions of space (height, width, and length). If bone volume is deficient in any of these dimensions, then bone grafting is necessary in order to prepare the ridge for placement of an implant to ensure its long-term success. With bone grafting we now have the opportunity to not only replace bone where it is missing, but we also have the ability to promote new bone growth in that location. This gives us the opportunity to place implants of proper length and width, and also restore natural functionality and aesthetic appearance.
What causes bone loss?
There are many reasons for bone loss in our jaws, including:
- Short or long term absence of teeth
- Periodontal disease
- Traumatic loss from dental and facial injuries
- Orthodontic or dental crowding
- Jaw cysts and tumors
- Developmental deformities
The most common reason for jawbone loss and inadequate bone volume for an implant is simply due to the absence of a tooth or teeth in any area of the jaw. In the same way that muscles are maintained through exercise, bone tissue is maintained by use. Natural teeth are embedded in the jawbone and stimulate the jawbone through activities such as chewing and biting. When teeth are lost from dental disease, extraction, or trauma, the “alveolar bone”, or the portion of the jawbone that anchors the teeth into the mouth, no longer receives the necessary stimulation it needs and begins to break down, or resorb. The body no longer uses or “needs” the supporting bone in this area, so it deteriorates. Even if a single tooth is lost, the bone in that area will decrease in volume. This is why if a tooth or teeth have been missing in an area, even for as short as a year, a bone graft sometimes may be required in order to restore the bone at that site prior to implant placement.
What type of bone graft materials are used?
The graft material that we use for the majority of our bone grafting procedures is “bottled bone” that requires no additional surgical sites to harvest. The most common types of grafts used include:
- Allogenic Bone: Graft material that has been obtained from another human donor
- Xenogenic Bone: Graft material that has been obtained from a donor of another species (most commonly bovine or cow)
- Autogenous Bone: Bone graft obtained from your own bone, typically obtained from the wisdom tooth region of the lower jaw or the chin (this type of bone graft is reserved only for larger grafting procedures and is not typically required)
All donated bone graft materials are obtained from well respected and FDA approved tissue banks and have undergone processing to eliminate the risk of disease transmission or immune reaction and ensure sterility. Donated grafting materials have the advantage of not requiring a second surgical site to harvest bone.
How does the graft material work and how long does it take to heal?
Once the graft materials are surgically placed at the site needed, they act to restore bone volume by two methods. First, the graft material acts as a scaffold or building block upon which your own body’s bone forming cells can use to create the structure of new bone in the site. Second, some of the graft materials contain special proteins called growth factors that actually induce your natural bone cells to deposit bone in the site of the graft. Generally, 4-6 months is needed after placement of the graft material in order to allow the bone to remodel and mature into your own natural bone. However, the surgical recovery period is much quicker. Most people experience normal post-operative soreness and swelling that peaks around 2-3 days after surgery, but is well controlled with icing and oral pain medication. A weekend of recovery is generally quite sufficient for most patients.
What are the most common types of grafting procedures?
Bone grafting procedures are essential to either preserve or increase the amount of bone volume in the site of anticipated implant placement. Depending on the location and type of procedure, there are several different names that we use to describe the specific procedure. The most common types of these grafting procedures include:
- Socket Preservation: This procedure is used for patients needing a tooth extraction and desiring a future implant. When a tooth is extracted, the loss of the chewing stimulation in this site of the jawbone results in a gradual, yet immediate process of bone resorption or loss. Scientific studies have shown that the placement of bone graft material into the socket at the time of tooth extraction actually significantly decreases the rate of bone loss and results in better bone volume for implant placement. Once the tooth is extracted, graft material is carefully packed into the socket and covered with a dissolvable collagen dressing that is secured in place with dissolvable stiches. After 3-4 months of healing, an implant is then placed at a second surgery appointment. This procedure does not result in increased post-operative pain or swelling when compared to a tooth extraction alone.
- Ridge Augmentation: This procedure is used in order to restore an existing deficiency in either bone height or width in preparation for a future implant placement. This may be needed in a site that has been missing a tooth for a period of time or at the same time of extraction of a tooth that has significant bone loss from periodontal disease. An incision is made in the gum tissue and a pocket is created between the gum tissue and the jawbone. Grafting material is then packed into this pocket and sometimes covered with a dissolvable membrane to help preserve the volume of the graft. Finally, the gum tissue is then closed with dissolvable stiches. After 4-6 months of healing, an implant is then placed at a second surgery appointment.
- Sinus Lift: This procedure is used in order to increase the amount of bone height in preparation for an implant in the back portion of the upper jaw. In our maxilla or upper jaw, our molar and premolar teeth roots protrude into a hollow cavity known as the maxillary sinus. After a tooth extraction or even with normal aging, the presence of maxillary sinus can decrease the amount of bone height present in this region for placement of a dental implant. The shortest dental implant that can provide reliable stability for a molar or premolar tooth is about 10 mm, so at least this must bone height must be present for a dental implant placement. If there is inadequate height of bone in this area, a sinus lift procedure may be necessary in order to increase the bone height to allow for an implant placement. This procedure involves lifting the sinus membrane that lines the sinus and packing graft material beneath it. If only a small amount of height needs to be achieved, this grafting procedure can be done at the time of implant placement. However, if a larger amount of bone height needs to be achieved, this procedure is performed first and then an implant is placed 4-6 months later.
Bone Grafting Presentation
For a brief narrated overview of the bone grafting process, please click the image below. It will launch our flash educational MiniModule in a separate window that may answer some of your questions about bone grafting.
Bone Grafting Overview
For a brief narrated overview of the bone grafting process, please click the image below. It will launch our educational MiniModule in a separate window that may answer some of your questions about bone grafting.
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