Over a period of time, the jaw bone associated with missing teeth shrinks. This results in poor quality and reduced amount of bone suitable for placement of dental implants. Today, we have the ability to replace bone where needed. This not only gives us the opportunity to place implants of ideal length and width, but also allows us to restore function and esthetics.
Major Bone Grafting
Bone grafting can enhance implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. We typically use your own bone, 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. 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 patients 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 require a hospital stay of one or two days.
Sinus Lift Procedure
The maxillary sinuses are above your upper posterior teeth. Some of the roots of upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often 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 and its called a sinus graft or a sinus lift. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and bone is inserted into the floor of the sinus. After several months of healing, the bone becomes part of the patients jaw and dental implants can be inserted and stabilized in this new sinus 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. If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique 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 implant.
The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be repositioned in order to make room for placement of dental implants to the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and 2nd 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 resolves only very slowly, if ever). Usually other, less aggressive options are considered first. Typically, we remove the outer wall of the lower jawbone in order to expose the nerve. Then we isolate the nerve and vessel bundle in that area, and pull it out to the side. At the same time, we place the implants. Then the bundle is released and placed back over the implants. The surgical access is refilled with bone graft material of the surgeons choice and the area is closed. 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 mandibular ramus or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. When we use the patients own bone for repairs or addition, we get the best results. These surgeries are performed in the out-office surgical suite under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.