Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. 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 are not candidates for placement of dental implants.
At Northeast Oral Surgery and Dental Implant Center, our doctos have the ability to grow bone where it is 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 the aesthetic appearance for our patients.
Bone grafting can repair 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 require a hospital stay.
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.
There is a solution. It is called a sinus graft or sinus lift graft. The doctors at Northeast Oral Surgery and Dental Implant Center have been surgically trained to enter 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. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw. Dental implants can then be inserted and stabilized into this new sinus bone.
The sinus graft makes it possible for a wider range of patients to have dental implants. Years ago, there was no other option other than wearing loose dentures for these patients.
If enough bone is available between the upper jaw ridge and the bottom of the sinus to stabilize the implant, sinus augmentation and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation must be performed first, allowing the graft to mature or heal for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
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In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. The technique of ridge expansion is used to restore the lost bone dimension, when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the dental implant.
The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants in the lower jaw. This procedure is limited to the lower jaw and is indicated when teeth are missing in the area of the two back molars and/or and second premolar, with the above-mentioned secondary condition. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever), less aggressive options are always considered first (placement of blade implants, etc.).
Typically, an outer section of the cheek side of the lower jawbone is removed in order to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area and slightly move it to the side. At the same time, we will place the implants. Then the bundle is released and placed back over the implants. The surgical access is refilled with bone graft material and the area is sutured.
These procedures 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 harvested from the hip or the outer aspect of the tibia at the knee. When the patient’s own bone is used for repairs, generally, the best surgical results occur.
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. We even use factors from your own blood to accelerate and promote bone formation in graft areas.
These surgeries are typically performed in the hospital, under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day with limited physical activity for one week.
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