Treatments

Bone Graft (Augmentation)

Note: Grafts, like natural teeth, protect the jaw bone to the same extent. When there are no teeth of grafts, the bone is absorbed faster.

Note: The source of the bone for transplant can come either from the patient, a bank (animal bones) or a synthetic substitute.  The doctor will decide which is more suitable in your case, after the advantages and disadvantages are explained to you.

Introduction

The key to success with dental implants is the quantity and quality of bone into which they can be inserted. After losing teeth due to periodontitis, extractions or accidents, osteoporosis occurs that makes inserting implants more difficult. To prevent or to correct this situation, it is necessary to reconstruct the ridge of the jaw through augmentation.

What is augmentation (bone graft)?

Augmentation is the process of building a three dimensional bone ridge by grafting bone. Doing so promotes future implants:

  1. Preserving the ridge: immediate augmentation serves as preventative care following dental extraction
  2. Delayed augmentation: occurs in stages
  3. Augmentation may be performed together with implant insertion
  4. Various augmentation methods exist

(1) Ridge preservation

Immediate augmentation as preventative care for dental extractions: in general, correct and diligent care of the gums prevents osteoporosis. However, extraction of teeth is accompanied by a natural process of jaw osteoporosis. Preventative care involving immediate augmentation is carried out on the day that the tooth is extracted.

The treatment’s procedure

Once the extraction and removal of infection are complete, a bone graft is carried out and a membrane positioned to preserve the jawbone’s volume and prevent osteoporosis. The new bone together with the membrane prevent damage and future dramatic osteoporosis that may make inserting implants more difficult. Only immediate augmentation can ensure the needed quality and quantity of bone for successful dental implantation several months into the future.

(2) Delayed augmentation

Concept and purpose

If immediate augmentation is not performed on the day of dental extractions, and damage develops that makes implantation difficult, it is essential that augmentation is carried out in phases, which involves bone grafting some weeks or months after the extractions. Delayed augmentation corrects bone damage by restructuring the three dimensional jaw ridge. Types of augmentation are lateral (thickness), vertical (depth) or both integrated.

The treatment’s procedure

Initially the gums are lifted, the damaged bone exposed, and a bone graft is performed. When the bone graft is taken from the patient’s own mouth, the bone will be collected as a lump (block) or as grains from the areas of lower front teeth or the wisdom teeth. Later, a membrane will be positioned to protect the implant. In some cases it is possible to insert implants immediately while structuring the ridge of the jawbone. In other cases, it is necessary to complete the recuperation period of some 4 to 6 months first.

(3) Augmentation integrated with implants

When the amount of bone missing is only minimal, the dental implant can be performed simultaneously with the bone augmentation process. The implant is inserted into the patient’s natural bone. The natural bone is then augmented with bone substitute to ensure the implant’s stable positioning.

(4) Common augmentation methods

GBR – Guided Bone Regeneration

This method, which builds up natural bone by using bone substitutes and membranes is safe and promises very good outcomes in most cases.

Bone augmentation using bone blocks :
A small chunk of bone, called a block, is taken from the patient’s mouth and transplanted to the required area, becoming the basis for new bone growth. The method is highly effective but more sensitive, and is therefore only recommended in more complex cases.

Bone splitting and alveolar ridge reconstruction:
In cases where the bone ridge is particularly narrow, it can be thickened by splitting it, then expanding it.

Alveolar Distraction Osteogenesis – Gradual ridge reconstruction(Alveolar Distraction Osteogenesis)

The procedure is similar to orthopedic bone stretching, and is very common in Asia. Where significant amounts of ridge bone are missing, a medical fracture is made and a mechanical device similar to a dental implant is inserted. The device is mobile and promotes new bone growth, until the entire area is suitable for receiving implants.

Maxillary sinus floor elevation

This procedure is necessary when the upper back jaw has insufficient bone to support implants. It is a commonly found status resulting from extraction of upper molars and their proximity to a space known as the right or left maxillary sinuses, so called because these two sinuses are part of the upper maxilla (upper jaw). In the past, this area was one of the most difficult in which to insert implants.

The treatment procedure

After a clinical examination that includes computerized tomography (CT), the Periodontist will discuss suitability of sinus floor lifting with the patient. A sinus floor lift is in fact an “upwards (vertical) augmentation”. The sinus floor lift can be performed in several ways. The most common involves an incision that exposes the bone. A window is opened into the sinus, into which the bone is then grafted. After closing the gums, the new bone’s assimilation and healing period commences. Implants can be inserted some 6 to 9 months later. Occasionally, the implant can be inserted simultaneously with the sinus floor lifting procedure, but this will depend on the quality and depth of the currently existing bone. Sinus floor lifting is a safe, excellent method involving minimal discomfort. It does not require hospitalization, is performed under either localized or deep sedation in the clinic, and enables implantation in an area previously considered highly problematic.

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