Over a period of time, the jawbone associated with missing teeth atrophies ( shrinks) or recedes. This often results in the presence of less than adequate bone density/volume suitable for placement of dental implants. In the past, most patients in this situation were denied the placement of dental implants.
Today, we have the techniques and biomaterials to graft or grow bone where needed. This not only gives us the opportunity to place implants of sufficient sizes in the prosthodontics guided 3D position, it also gives us a chance to restore functionality and aesthetic appearance.
Types of Bone Grafting
Bone grafting is a broad term that covers a simple procedure such as filling an extraction socket with bone substitute materials or pasting bone fillers around an implant to treat a minor defect to major grafts of bone transplantations from other parts of the body such as the lower jaw or the hip bone. The latter are reserved for major reconstructions such as after cancer surgery or road traffic accidents.
MINOR GRAFTS or AUGMENTATIONS
Minor bone grafting such as immediate socket augmentation after an extraction, can repair potential implant sites with damaged bone structure due to previous extractions, infections, gum disease or injuries.
There are different Biomaterials that are commonly used for minor augmentations with “bone in a bottle”. These have animal, human or purely synthetic origin and include: a) bone elements of cow bone origin (xenograft), b) bone from human donor origin obtained by tissue banks as part of multi-organ donor scheme, c) synthetic bone of calcium phosphate origin or d) your own bone is taken from the jaw, hip or tibia (below the knee). For minor augmentations normally xenografts of cow bone origin are used with long term safety and efficacy shown through extensive clinical studies spanning over decades both in orthopaedic surgery and oral surgery.
At UCER Clinic we use your own growth factors obtained from a sample of your own blood to accelerate and promote bone and soft tissue formation in graft areas. This regenerative medicine technique is known as Platelet Rich Plasma (PRP) or Platelet Rich Fibrin (PRF). (see below)
These options are discussed as part of the treatment planning process with each individual patient and a biomaterial of appropriate choice is chosen (also taking account of religious and personal beliefs).
RIDGE AUGMENTATION:
The jawbone will lose 30-40% of its volume within the first 3 months after tooth extraction. Bone loss can result in oral health issues and physical changes to your facial profile. This could cause significant changes to your overall dental function, phonetics of your speech and aesthetic appearance of your face. Jaw bone Ridge augmentation is a reconstructive method for replacing the missing bone and gum tissue to restore proper anatomy, contour and function, as part of the dental implant process. The ridge augmentation process involves sculpturing the natural contour of the jaw and gums using bone and/or gum graft material. Once the area has healed and the contour of the alveolar ridge is restored, the dental implants are placed at a later stage.
MAJOR GRAFTS or AUGMENTATIONS
Major bone grafts are typically performed to repair moderate to large amounts of bone loss or defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Very large defects ( e.g. after extensive cancer surgery or road traffic accidents) are repaired typically using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The lower or upper jaw, the 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. Fortunately, these procedures are exceptional and infrequently required for the majority of patients.
Sinus lift bone grafts are also indicated commonly to replace bone in the back of the upper jaw when replacing back teeth (molars).
SOURCE OF BONES AND BIOMATERIALS
There are different Biomaterials that are commonly used for minor augmentations with “bone in a bottle”. These have animal, human or purely synthetic origin and include: a) bone elements of cow bone origin (xenograft), b) bone from human donor origin obtained by tissue banks as part of multi-organ donor scheme, c) synthetic bone of calcium phosphate origin or d) your own bone is taken from the jaw, hip or tibia (below the knee). For minor augmentations normally xenografts of cow bone origin are used with long term safety and efficacy shown through extensive clinical studies spanning over decades both in orthopaedic surgery and oral surgery.
At UCER Clinic we use your own growth factors obtained from a sample of your own blood to accelerate and promote bone and soft tissue formation in graft areas. This regenerative medicine technique is known as Platelet Rich Plasma (PRP) or Platelet Rich Fibrin (PRF). (see below)
These options are discussed as part of the treatment planning process with each individual patient and a biomaterial of appropriate choice is chosen (also taking account of religious and personal beliefs).
Sinus Lift bone grafts
The Maxillary sinus is a medium size empty air cavity located within the upper jaw bone where the roots of molar teeth are normally embedded. When these upper teeth are removed, there can be a thin layer of bone left to separate the maxillary sinus from the mouth. When the sinus wall is very thin, it may not be possible to place traditional dental implants in this area. The procedure to augment or grow bone below the floor of the maxillary sinus cavity is called a “sinus lift graft” or “sinus augmentation”.
To place implants, the floor of this air cavity bordering the teeth is filled with bone substitutes or biomaterials. A xenograft (cow bone origin) is the material of choice for this procedure used very safely and successfully over decades. Special dissolving membranes are used under the gum to protect the bone graft and encourage bone regeneration. This is called guided bone regeneration (GBR). Membranes can be synthetic or porcine in origin.
If there is a borderline amount of bone remaining between the ridge of the upper jaw and the floor of the sinus cavity to stabilize the implant, sinus augmentations and dental implant placement can sometimes be performed as a single procedure. This is known as “simultaneous sinus lift” meaning that it is carried out at the time of implant placement. If not enough bone is available, the sinus lift is performed first and the graft is allowed to mature for a few months ( 6 to 8 months). Once the graft has matured, the implants can be placed. This is referred to as “staged sinus lift”.
DAYCARE ANAESTHESIA FOR BONE GRAFTING
The Graft surgery is normally performed in the our daycare operating and recovery suite under iv conscious sedation provided by a Consultant Anaesthetist and team. Treatment is carried out painlessly whilst you are sedated. The treatment is provided without rush and you are allowed to recover in a private room before going home.
Graftless Dental Implant Reconstructions
Zygomatic (longer dental implants) may eliminate the need for major types of grafting ( see Zygomatic implants)
In recent years, advanced techniques such as Zygomatic and Pterygoid Implants, All on Four Procedures using 3D diagnostic and planning technology and computer guided surgery have eliminated the need for large grafts in our centre except for a minority of patients with extremely large defects.
What Are the Different Types of Bone Grafting Procedures?
Bone grafting can range from minor augmentations, such as filling an extraction socket with bone substitutes, to major grafts involving bone transplants from other parts of the body. Minor grafts repair potential implant sites with minor defects, while major grafts address significant bone loss due to trauma or surgery.
What Biomaterials Are Used in Bone Grafting?
Various biomaterials are used in bone grafting, including xenografts (cow bone origin), human donor bone from tissue banks, synthetic bone materials, and autografts (patient's own bone). The choice of biomaterial depends on the patient's specific needs, medical history, and personal or religious beliefs.
How Does the Ridge Augmentation Procedure Work?
Ridge augmentation is a reconstructive method that restores the jawbone and gum tissue to their natural contour after tooth extraction. This procedure involves sculpting the jaw and gums with bone and/or gum graft material, allowing for dental implants to be placed later.
What Is a Sinus Lift Bone Graft and When Is It Needed?
A sinus lift bone graft is a procedure that augments the bone below the maxillary sinus floor to allow for dental implant placement in the upper jaw. This graft is necessary when the sinus wall is too thin to support implants. It can be done simultaneously with implant placement if there is borderline bone availability or as a staged procedure if more bone is needed.
