For dental implants to be effective, the jawbone needs to have sufficient bone to support them.
Missing teeth often causes more loss of bone over time. The tooth loss might be caused by:
- Gum disease
- Dental caries (cavities) and infection
- Injury or trauma
- A problem in development
If the bone under your gum is not high enough, not wide adequate or both, you will require a procedure to include bone to your jaw prior to implants can be placed.
What Is Dental Bone Graft?
Bone enhancement is a term that describes a range of procedures used to “construct” bone so that dental implants can be placed. These treatments generally involve grafting (adding) bone or bonelike materials to the jaw. The graft can be your very own bone or be processed bone (off the rack) acquired from a cadaver. After implanting, you need to wait numerous months for the grafted product to fuse with the existing bone. “Off– the-shelf” grafted products either cause surrounding bone to grow into the graft or cause cells around the graft to become bone. A graft from your own bone transplants bone cells or a block of bone that fuses to the jaw.
Numerous different treatments can be used for bone augmentation. Your dental practitioner will pick one depending on the type, location and number of implants to be used. If you require a bone graft, it is important that you and your dental professional talk about all the choices offered to you.
After bone enhancement, dental professionals typically wait four to nine months prior to placing implants.
Where Does the Bone Come From?
The majority of bone augmentation treatments involve the use of bone grafts. An exceptional choice for a bone graft is your very own bone. This more than likely will originate from your chin or ramus (the back part of your lower jaw). If your dental professional can not get enough bone from these areas, she or he might have to get bone from your hip or shin bone (tibia) instead. The hip is considered to be a much better source because the hip bone can offer a large quantity of bone. The marrow from either the hip or shin (tibia) contains bone-forming cells. Nevertheless bone drawn from your hip needs a hospital stay and basic anesthesia.
If you do not like the idea of having bone got rid of from your body to be positioned in your jaw, other excellent options are offered. Your dentist can use materials made from the bone of human cadavers or cows. Synthetic materials also can be used for bone grafting. Newer products, such as bone morphogenetic protein-2 (BMP-2), likewise are readily available. BMP-2 stimulates specific body cells to develop into bone, without grafting. This protein happens naturally in the body. The dental material is produced utilizing DNA innovation. You must discuss your options and their dangers and benefits with your dental expert prior to any procedures are done.
A Common Bone-Augmentation Procedure
In a normal scenario, a patient has lost a single tooth and wishes to have it replaced with a crown supported by a dental implant. Nevertheless, the tooth has been missing for numerous years and there is insufficient bone to support the implant.
In this case, bone drawn from the patient’s chin or from a cadaver can be used to “restore” the lost bone so that it can support an implant. This kind of procedure is performed in the cosmetic surgeon’s office under intravenous (IV) sedation. Before the procedure, you will have to have a cone-beam computed tomography (CT) scan. This offers a 3-D image of your bone.
Regional anesthesia will be used to numb the area where the bone augmentation is needed (recipient site) as well as the area from where bone will be eliminated (donor site). A cut (cut) in the gum where the implant will be put is made to determine how much and what type of bone is required.
If the bone is drawn from the chin, then the surgeon will make a cut in the gum below the lower front teeth to expose the chin bone. A block of bone will be gotten rid of from the chin along with any bone marrow. Numerous dental professionals fill the spot where the bone was removed with another type of bone-graft material. They might cover this with a thin movie of tissue to keep gum tissue from filling the space as it recovers. The incision is then closed with stitches.
The block of bone that was gotten rid of from the chin will be anchored in location with small titanium screws. A mixture of your bone marrow and some other bone-graft material might then be placed around the edges of bone block. Lastly, the cosmetic surgeon may place a membrane over the graft and close the cut.
After a bone enhancement procedure, you will be given antibiotics, pain medication and an antibacterial mouthwash. You will be asked to prevent particular foods. You likewise will be told how to avoid putting pressure on the area while it heals. If you use a denture, you may not have the ability to wear it for a month or longer while the area heals. If you have natural teeth near the bone graft, your dental practitioner may make a temporary removable bridge or denture to help safeguard the area.
The bone graft will take about six to nine months to recover prior to dental implants can be put. At that time, the titanium screws used to anchor the bone block in location will be gotten rid of before the implant is put.
Building Up Bone for Several Implants
Many people are missing out on several teeth and require several implants. If bone needs to be developed to support several implants, a lot more bone graft product will be required than if a single implant is being put. If you are having several implants placed and decide to use your very own bone for a bone graft procedure, the bone may be drawn from your hip, shin or another site. This type of procedure is carried out in the health center under general anesthesia.
You might invest a couple of nights in the medical facility if you have bone collected from the hip. A bone graft from the hip is actually taken from the ilium, which is above the hip joint. This does not increase your risk of hip fracture.
Some surgeons will get rid of bone from the shin in their office. You will be given a shot to numb the area (regional anesthesia) and medicine through a vein to make you sleepy (intravenous sedation). Lots of surgeons may likewise use bone from a cadaver in the workplace, without eliminating any of your very own bone.
Success of Bone Grafting
The success rate for bone grafts in the jaws for the purpose of placing dental implants is really high. However, there is constantly a chance that the bone graft will fail, even if your very own bone was used. Bone grafts are not declined like organ transplants. Dentists have no idea why some bone grafts fail. They do understand that particular people– such as those who smoke and those with specific medical conditions– have higher dangers of graft failure than others do.
A failed graft will be removed. Once the area has recovered, your dental expert might opt to position a 2nd graft.
Other Types of Bone-Augmentation Procedures
In addition to bone grafting, lots of other types of procedures can be used to develop bone for positioning of implants.
One procedure is called a sinus lift (or elevation). It increases the height of your upper jaw by filling part of your maxillary sinus with bone. The maxillary sinus is the area above your jaw on either side of your nose above the back teeth. This is done when the back part of the upper jaw does not have enough bone to allow implants to be put.
A ridge expansion is a type of bone graft that can be done when the jaw is not large adequate to support implants. Your dental practitioner uses an unique saw to split the jaw along the top (ridge) and packs graft material into the newly developed area. Some dentists will put implants directly after this procedure. Others will wait several months for the ridge to heal. This procedure, called a split ridge technique, can be carried out in the dental office under local anesthesia.
A bone enhancement procedure that is carried out less typically is called interruption osteogenesis. It is used frequently to increase the height of bone that is too short. This procedure initially was used for lengthening the bones of individuals with unusually short legs. It now has actually been adjusted for use in the mouth.
A surgeon makes cuts in your jawbone to separate a piece of bone from the remainder of the jaw. A titanium device placed with pins or screws holds the piece of bone apart from the remainder of the jawbone. Each day, you unscrew the device a percentage. With time, this makes the area in between the piece of bone and the jawbone taller. The area between the pieces slowly fills in with bone.
“Interruption” refers to the procedure of separating the two pieces of bone. “Osteogenesis” describes the forming of new bone. Interruption osteogenesis is used more frequently to make the jawbone taller, but it can be used to increase the bone in any direction. The procedure is becoming more typical.
Nerve Repositioning
A nerve called the inferior alveolar nerve goes through the lower jaw. This nerve provides feeling to the lower lip and chin. In patients who have actually lost substantial amounts of lower jawbone, it may not be possible to place implants without harming this nerve. To resolve this issue, an oral cosmetic surgeon can drill a little window in the bone and move the nerve to one side. The implants then can be put through the bony canal formerly filled by the nerve. This strategy is not used very typically due to the fact that it is possible to damage the nerve just by moving it.