Bone grafting procedures,
More times than not, if you and your dentist have determined that placing an implant is your best option, this will be possible without additional surgeries.
However, depending on the time elapsed since the teeth were removed as well as the local anatomy, some additional preparatory bone grafting may be necessary. Almost invariably this will add some overall time to your treatment, but in the scheme of things, always remember 'good things come to those who wait'.
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When a tooth is removed, the body will begin to heal the extraction socket. This process can take several weeks or even months to complete. During this time, one hopes for the socket to heal with bone in all dimensions (i.e. width and height). There is some reasonable evidence both in the literature and anecdotally that left to its own devices of healing that there may be bone loss during the healing stages. This bone loss is reported to be in the realm of 20%. If the tooth is being removed in an aesthetic zone (i.e. front of the mouth) or if losing 20% of the bone would likely mean placing an implant there could be compromised, it is recommended to place some bone grafting substitute in the extraction site. This seems to lead to a more predictable healing outcome as the bone placed acts as a scaffold for your own bone to grow in to. Depending on the bone product used, it is generally turned-over by your body's healing within a year or less. An implant can usually be placed within 3 months of the extraction/bone grafting. This will be discussed during your consultation.
The second, not-to-uncommon circumstance is when a tooth is removed due to bone loss from
periodontal disease, fracture or deep decay. In this instance substantial bone may
already be lost from the outer bone (buccal plate) and again, if this area is left to heal on its
own there likely would be a signficant concavity of bone. This may - if nothing else - make the
placement of an implant more difficult. In this instance it is almost certainly advised to graft the
area as shown in the figure (right). While this doesn't guarantee the presence of adequate bone
and aesthetics, it is certainly the right thing to do.
The grafting procedure adds little time and cost to the overall procedure and keeps options
open for you should you wish to have that implant int he future.
Alveolar ridge grafting:
There will be instances when your tooth has been removed long ago or had been removed in the context of periodontal disease or a fractured tooth. As mentioned above, any of these instances can lead to the loss of bone where we would like to place an implant.
Using any of a number of options, bone can be replaced in this area. It is vital to have solid bone in the area of the proposed implant since this serves as the foundation of your implant. Anything foundation that is less than solid will only get worse from the point your implant is placed.
Sometimes the bony defect is significant enough to warrant the use of a piece of your own jaw
bone as is shown to the right. Though this does require surgery in a second site, it allows for
us to use your own bone (reliable for grafting). These grafts occasionally require a slightly longer
healing time (up to 6 months), research and experience has shown these to be predictable, safe
and reliable. Bone can be harvested from the front of the lower jaw or the back (there is no
discernible aesthetic or functional change for the patient after this). Again, this graft can be
done under local anesthesia but may be more comfortable with sedation.
Other methods may exist to enable the surgeon to have bone present to place an implant; these include:
Non-bone materials (e.g. BMPs)
As you can see, there are good reasons to have a consultation with the surgeon before your actual procedure.
Above the upper back teeth is an air-filled cavity called the maxillary sinuses. Sometimes as a result of your specific anatomy or being without a tooth/teeth in that area, that sinus may take over the bone where the tooth roots would reside. Insofar as normal health with teeth, this is really not a problem. On the other hand, it might be an issue should one want to place an implant in the area. Why? We like to place implants in bone because if they're placed in the sinus (air) that really doesn't help their stability or anchorage.
By making a small incision in the gum, and exposing the sinus membrane, we can tease that membrane up and graft the void below with bone (direct sinus lift). That will us to place the implant in actual bone.
If a lesser amount of "lift" is required, often we can use an instrument to push up the sinus floor from the implant area (indirect sinus lift) avoiding the need for a separate formal surgery.