Major & Minor Bone GraftingOver a period of time, the jawbone associated with missing teeth atrophies or is resorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients would not be candidates for the placement of dental implants unless modern bone grafting techniques were employed. 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 aesthetic appearance.
Major Bone Grafting
Bone grafting can repair potential implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee). 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. Major 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 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 in an operating room and may require a hospital stay.
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.
Sinus Lift Graft 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. The solution is called a Sinus Lift Graft. The oral and maxillofacial surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus which is sometimes further augmented with platelet rich plasma. 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 removable 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.
Ridge Expansion and Onlay Ridge Augmentation
In severe cases, the ridge has been resorbed and has become atrophic requiring that a bone graft be placed, to increase ridge height and/or width, prior to implant placement. These techniques are used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In the ridge expansion procedure, the bony ridge of the jaw is expanded by mechanical means and bone graft material is placed within the confines of the newly contoured jaw bone. For the onlay ridge augmentation procedure, bone graft material is placed adjacent to the bone defect and covered with a collagen membrane. With both techniques, the bone graft material is allowed to mature for a few months before placing the implant.
INFUSE (Recombinant Human Bone Morphogenetic Protein Type 2)
This material consists of two parts; a protein found in everyone’s body plus a natural collagen carrier. The protein ingredient is a synthetic version of a protein that the body uses to regulate bone growth and healing. The collagen carrier releases the protein slowly over time and provides a framework for new bone to grow into as it is absorbed and replaced by the new bone. Using INFUSE Bone Graft, eliminates the need for a second surgical site to harvest the patients “own bone” while still achieving natural bone growth from the patient directly.
All of these procedures mentioned above, may be performed separately or together, depending upon the individual’s condition. As stated earlier, there are several areas of the body that are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region, or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or other skeletal regions. In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to promote the patient’s own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation as well as the use of recombinant proteins (Infuse.) We can even use factors from your own blood to accelerate and promote bone formation in graft areas (Platelet Rich Plasma.)
Learn More About Bone Grafting
For more information, or to schedule a consultation appointment, call our offices in West Orange NJ at West Orange Office Phone Number 973-736-7616, West Caldwell NJ at 973-575-8575 or Parsippany NJ at 973-335-3777.