Bone grafting procedures,

Reconstruction &

Implants

 

 

  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'.

 

  Click on the links below for more information regarding: 

Maxillary Reconstruction:

 

Once a tooth or teeth are removed, the body has no inherent reason to maintain the bone in that area any longer.  The loss of bone in the maxilla (upper jaw) occurs at a rate four times quicker than in the mandible (lower jaw).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comprehensive reconstruction of the maxilla is not the same as placing a small amount of bone in a single area for one implant.  It is generally more surigcally involved and may require any combination of:

  • Grafting of the jaw with bone taken from other areas of the body

  • Use of adjunctive biomaterials (e.g. rhBMP)

  • Sinus lifting and grafting

  • Re-positioning of the maxilla forward and/or downward to place it in a more normal, aesthetic and funtional position

 

Generally speaking, the longer it's been since the teeth were removed the more bone that is lost and the more reconstruction that is inherently required.

 

 

Maxillary atrophy:  Once a tooth is removed (B), the bone quickly starts to disipate.  Once bone is lost to the extent of (D), conservative bone grafting is necessary for implant placement. When bone loss progresses to (E,F), the ability to wear a conventional denture is typically compromised and implant placement requires significant bone grafting.

 

Mandibular Reconstruction:

 

Once a tooth or teeth are removed, the body has no inherent reason to maintain the bone in that area any longer.  Generally, bone is lost more rapidly towards the back of the lower the jaw.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

As with maxillary reconstruction, comprehensive reconstruction of the mandible is not the same as placing a small amount of bone in a single area for one implant.  It is generally more surigcally involved and may require any combination of:

  • Grafting of the jaw with bone taken from other areas of the body

  • Use of adjunctive biomaterials (e.g. rhBMP)

 

Generally speaking, the longer it's been since the teeth were removed the more bone that is lost and the more reconstruction that is inherently required.

 

 

Mandibular atrophy:  Once a tooth is removed (B), the bone quickly starts to disipate.  Once bone is lost to the extent of (D), conservative bone grafting is necessary for implant placement. When bone loss progresses to (E,F), the ability to wear a conventional denture is typically compromised and implant placement may require significant bone grafting.

Mandibular bone loss also leads to the loss of support for facial soft tissue.  Because the facial soft tissue is supported by the underlying bone, a loss in this bony support will lead to a commensurate loss in facial support leading to a more aged, sunken-in appearance.  This appearance can be camoflauged with dentures or, more permanently restored with reconstruction of the jaw.

rhBMP (recombinant human bone morphogenetic protein):

 

In order to restore bone, the body needs to have a signals that bone is needed there once again.  Historically, this is done by placing bone in aposition to existing bone (bone grafting).  This grafted bone gives the signals required for new bone to grow and occupy the area of the grafted bone.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Advantages of rhBMP-2 include:

  • May preclude the need for a second surgical site

  • Results in prolific and robust bone induction 

 

Disadvantages of rhBMP-2 include:

  • Comparatively more expensive

  • May result in more short-term swelling (this is desirable as it suggests the BMP is doing its job)

  • May be inadequate on its own to provide the amount of bone needed

 

 

 

rhBMP-2 can signal the body to lay down new bone.  One of the most potent inducers of new bone formation is the molecule rhBMP-2.  It has been cloned, synthesized and made available as a bone grafting substitute.

PRF (platelet-rich fibrin):

 

During bone grafting-type procedures synthetic or collagen membranes are frequently used to contain the grafting material.  For the most part, these types of materials are inert and not biologically active.  PRF-derived membranes are produced from the patient's own blood and

are biologically active.  This is true because the PRF blood clot traps platelets that are a source of many growth factors that may accelerate healing and bone growth.  These factors include:

 

  • VEGF (vascular epithelial-derived growth factor)

  • PDGF (platelet-derived growth factor)

  • TGF-b (transforming growth factor beta)

  • and many many others...

 
 
 

Production of the PRF membrane. 

  1. Nurse draws 10-20 mL of blood into Vacutainer tubes;

  2. Tubes are quickly spun in a centrifuge to separate the layers of blood;

  3. The clot is found in the middle of the test tube and contains platelets;

  4. The obtained clot can be flattened and formed into a firm, resilient membrane

  5. The membrane can be used:  to cover a bone graft, in a sinus lift, or during an extraction procedure to preserve bone.

Bayside Oral &
Maxillofacial Surgery

If you have any questions please never hesitate to contact us.  

Telephone : 613-969-0333

Fax : 613-969-1574
Email : mzechel@baysideoms.com

Referrals: referrals@baysideoms.com

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© 2021 by Marc Zechel, DDS, MD, FRCD(C)