Bone Grafting & Sinus Lifts
Bone Grafting & Sinus Lifts
There are some cases where patients are not sure if they are good candidates for dental implants. Often, this is due to bone recession in the jaw and bone loss in an area where there are missing teeth. After a tooth has been removed, the jaw bone begins to recede or resorb, leaving an area of thinned bone with less height. Patients who have worn dentures for several years will notice that their dentures get loose, fit poorly and their face has a "sunken" appearance. This is due to bone recession and loss of the jaw bone structure in this area.
When this is the case, a procedure called bone grafting can often be performed in order to restore the bone height and width in the area. Some bone grafting procedures are very simple and only require the addition of bone about the neck of the dental implant. Other procedures to restore bone are more complex and require transplanting bone from one area of the jawbone to the needed area.
Little, Medium and Big Dental Bone Grafts
If you are missing a tooth, you definitely want to replace it with something, usually a dental implant or a bridge. Once a tooth is removed, the bone doesn't have anything to support anymore. Over time, it begins to slowly erode until it creates a hollow or a basin shaped divot in the jaw bone. If you try to place a bridge or a dental implant in a spot where the natural bone and gum tissue level is much lower than the surrounding areas a tooth in an area where the bone level is very low is going to make you look really "long in the tooth".
The Little Bone Graft
In the case of a lost tooth, there are a couple of ways to ensure that you will not lose excess bone height and width. Ideally, your dentist or oral surgeon will remove the damaged tooth and preserve the bone in the area using a simple bone grafting procedure. In this procedure, demineralized, sterile human bone granules, (which look like coarse sand), are packed into the tooth socket immediately after tooth extraction and may also be mixed with your own blood plasma to accelerate healing times. The granules are covered with a protective collagen membrane and a couple stitches are used to close the tooth socket. This procedure is simple and usually does not add to your recovery time. Over the next several weeks, your own bone will fill the tooth socket and preserve the bone height long enough for you to have the area restored. If you try to place a bridge or a dental implant in a spot where the natural bone and gum tissue level is much lower than the surrounding areas or where the bone level is very low is will make you look really "long in the tooth".
Medium Bone Grafts
If the tooth, or teeth were removed years ago, there is likely some bone loss hindering the restoration of the area. A slightly more involved bone graft may be needed. In this case, the area of the missing tooth is opened with a small incision, the bone surface is prepared and demineralized bone graft granules are used to build the area up. Many surgeons prefer to use a little bit of the patient's own bone in this procedure in order to ensure the best results possible. If your own bone is used, your surgeon will take it from another area of the jaw bone, usually near the wisdom tooth area. Again, the graft is protected with a special membrane and sutures are used to close it up tight. Over the next several months, the bone graft will heal and integrate with the surrounding bone tissue, successfully building up the width and height of the area so a nice restoration can be made. This type of graft can be used for one or multiple areas of missing teeth.
Big Bone Graft
Patients who have been missing many teeth for a very long time have often experienced advanced bone loss which prevents adequate restoration of the teeth. In denture wearers, the lower jaw bone often recedes so severely that their dentures no longer fit properly. The jaw bone in cases of advanced bone loss can be as thin as a pencil in some patients. These patients can no longer wear a denture successfully and do not have enough bone to place dental implants. Extensive bone grafting is necessary in order to restore the missing teeth as well as restore quality of life. In a procedure like this, a combination of demineralized, sterile human bone and the patient's own bone is used to build up the jaw bone, creating enough width and height to accommodate dental implants. The patient's bone is supplied by another part of the jaw, hip or tibia in the form of a small block. This block is anchored in place in the recipient site using specialized bone screws and sometimes plates. Bone granules are used to enhance the graft. The entire site is protected with a membrane, closed tightly with sutures and left to heal for a period of months before dental implants can be placed in the new bone.
The upper jaw has challenges of it's own. Patients missing upper molar teeth often experience extensive bone loss which causes the maxillary sinuses to become involved. The maxillary sinus is a hollow cavity which sits just above the molars in the upper jaw. When these teeth have been lost, the maxillary sinus often begins to dip down lower and lower. Combined with bone loss from the missing teeth, patient's can end up with just an eggshell of bone between their gums and maxillary sinus. You cannot place implants into a hollow cavity, so bone grafting is performed in order to raise the floor of the sinus and increase the depth and width of the bone in this area. This procedure is often referred to as a "sinus lift".
In the sinus lift, an incision is made in the gum tissue and a small window is created into the maxillary sinus cavity. Very carefully, the sinus membrane lining the sinus wall is detached and lifted. Demineralized, sterile human bone and the patient's own bone is combined and packed into the new space between the sinus membrane and the bone of the sinus floor. Once the desired thickness is achieved, a special collagen membrane is placed to protect the new bone and the window and gum tissue is closed with sutures. The width of the bone can also be augmented at this time in order to increase bone width in preparation for dental implants. A graft like this will need at least 4 months to heal before dental implants can be placed in the new bone.
Dental Bone Grafting Makes New Teeth Possible
Although bone grafting is a surgical procedure which can sometimes be rather extensive, it plays a very important role in making new teeth possible. In the not so distant past, patients without adequate bone height or width for tooth replacement with dental implants were simply told they couldn't have implants. These people didn't want to wear dentures or go toothless forever. The art and science of implant dentistry has brought us these highly specialized and successful techniques in order to restore what was lost and make it possible to have a beautiful smile. Bone graft surgery is temporary, but being able to eat, laugh, talk and smile lasts a lifetime!
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