We often hear from patients that they were told they are not able to get dental implants. That is typically not the case. There are few patients who cannot receive dental implants. Those patients are typically very ill with poorly controlled disease, active bone diseases or cancer and severely immunocompromised patients. The reason patients are sometimes told that they are not a candidate is a lack of boney support or bone loss. This problem does not have to be permanent. With the new advances in bone graft procedures and technology various types of bone grafting can be done to augment the previously lost bone. These are often difficult procedures that may take more than one surgery to achieve our goals but there are options available to improve the quality and quantity of available bone for implant placement. The question that becomes more accurate for patients is, “are you willing to go through these procedures?” and “are you willing to wait the amount of time necessary to achieve success with implants?”
The seriousness and invasiveness of these procedures is very case specific. Depending on whether the implants are needed in the upper jaw or lower jaw, front or back teeth may make a huge difference in the technique chosen and recovery time. It is important to discuss your treatment options with your general dentist or one of the oral surgeons here at Pottstown Oral and Maxillofacial Surgery to create a clear picture of your needs as a patient and the options for your specific case. During your consultation you will get a clear picture of your surgical needs, the recovery process and the financial implications which will allow you to make an informed decision about your dental implant options.
Bone grafting is a generic term meant to refer to a group of procedures that are utilized to add additional bone to an area where bone is either absent or deficient to correct a defect in the existing bone structure. There are many types of bone graft materials and many different methods of bone grafting. There have been entire textbooks written to describe these techniques and the materials commonly used so to try and explain all there is to know about bone grafting would be too great a task to tackle here. We will however attempt to answer some basic questions regarding the most common materials and techniques used in our practice.
What bone graft materials are available?
There are four basic types of bone used in bone grafting. Autogenous bone is bone taken from the same person and can be harvested from several different areas depending on the amount needed and the procedure being performed. Allograft bone is bone taken from the same species (human cadaver bone). This material is processed by the manufacturer to prevent transmission of disease or rejection of the material and is generally easy to use for small defects. Xenograft bone is bone taken from a different species. The processing of this material is very similar to cadaver bone and can also be used in small defect. Alloplastic graft material is synthetic chemicals or materials utilized to fill the boney defect. These materials vary widely in their composition and the amount of time necessary for the human body to process them.
What kinds of bone grafting techniques are available?
There are many techniques that can be used to replace or restore lost or missing bone. Block grafting utilizes a solid piece of bone and an attachment system of screws or tacks to secure it into position to fill a defect. It is most often used to increase both the height and width of a severely deficient area. The benefit of block grafting is that it is difficult for the body to resorb or dissolve the solid bone rapidly which allows it to be more stable in areas that will be under significant tension. Particulate grafting uses small particles of bone graft material to provide additional bone into an area of deficit. Particulate grafting is generally used in areas that requires minimal to moderate amounts of bone or in cases where a hollow defect is present. The main benefit of this material is the decreased healing time. The most common type of particulate grafting is socket preservation grafting where a tooth is removed and particulate graft material is used to fill the residual socket to prevent collapse in preparation for or during placement of a dental implant. Sinus lift bone grafts involve the placement of bone graft material into the maxillary sinus to vertically increase the amount of bone present. This is most common in the posterior maxilla (upper molar and premolar areas) where the sinus tends to invade the areas around the teeth. Other techniques which are less frequently used include distraction osteogenesis, ridge split bone grafting, and ridge split grafting.
Is bone grafting medically necessary?
Bone grafting of the upper and lower jaw is typically only necessary for the placement of dental implants. There are ways to avoid bone grafting in order to replace teeth such as crown and bridgework, zygomatic implants, short implants and nerve lateralization. None of these procedure themselves are without significant drawback including the damage to existing teeth, numbness, higher failure rates and permanent numbness. In most cases the risks of the more involved procedures will outweigh the issues involved with the bone graft placement option. To determine if bone grafting is required a consultation with one of our specialists will be required to fully evaluate the options. The utilization of bone grafting techniques is common in dentistry and our practice and has provided our patients and the general public with options that were not available in the past.