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, many patients are not candidates for placement of dental implants unless something is done to change the implant site.
Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place dental implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.
It is quite common, at the time of dental implant placement, for your surgeon to note that some volume loss has occurred in the bone surrounding the implant. While it is possible to place the dental implant and not modify the site, the better outcome is often to add a small amount of synthetic grafting material around the implant to restore the contour of the tissue where the tooth used to be. The advantage of this is that the prosthetic tooth can be of normal width as it “emerges” from the gum tissue and the finished crown esthetically mimics the natural tooth. The procedure itself adds little, if any, trauma and the additional cost is typically minimal. It simply affords a better, more natural, final result. These grafts can be done with natural bone, but it is more common to choose a synthetic material for ease and comfort.
There are times, even with a single tooth, where too much bone remodeling has occurred since the tooth was removed to allow dental implant placement. Remember, there needs to be enough bone to cover most of the implant in order to place it. In these cases, bone, either synthetic or natural, must be placed in the site and allowed to heal by remodeling with your own new bone. This usually takes about 4 months to proceed to the point where dental implant placement is possible. Thus, in these cases, the grafting procedure is performed first, allowed to heal for 4 moths, and then the implant placement is performed. As this requires two procedures, separated by four months, it adds some additional time to the dental implant process. Your doctor can discuss whether grafting might be necessary and if so, whether it would require a separate procedure. In some cases, you might be sent for special x-rays to allow your treatment planning to be performed more accurately.
The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them, lined with a thin layer of mucosa that resembles gum tissue. When you are born, the sinuses are very small or even absent. Over time they expand to fill the upper jaw, eventually often surrounding the upper tooth roots. When these upper teeth are removed, there is sometimes 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 of appropriate length in this thin bone.
There is a solution and it’s called a sinus graft or sinus lift graft. This procedure sounds daunting, but is the most predictable grafting procedure done in the jaws. The name “sinus lift” is somewhat confusing. In reality, your surgeon ideally stays out of the sinus entirely and via an incision in the gum tissue, moves the sinus lining out of the way and places a graft of synthetic or natural bone under this lining thus moving it upwards. After several months of healing, this graft becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new 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 dentures or a removable partial denture.
Commonly, enough bone between the upper ridge and the bottom of the sinus is available to stabilize the implant well but there is not quite enough bone to allow an implant of appropriate length to be placed. In these cases sinus augmentation and implant placement can be performed as a single procedure allowing no modification of the time to restore the crown. If not enough bone is available to provide stability for the implant, the Sinus Augmentation will have to be performed first, then the graft will be left to mature for several months, depending upon the type of graft material used. Once the graft has matured, the dental implant(s) can be placed.
Bone grafting can repair dental 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.) In addition, special synthetic 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 be outpatient procedures or require a hospital stay.
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