After losing teeth, the associated atrophy and reabsorption of the jawbone leaves behind bone too lacking in quantity and quality to suit dental implants. Advancements in modern dentistry allows us to place implants of an appropriate length and width in bone we have grown ourselves where it is needed, preserving our chances to restore our patients’ functionality and confidence in their aesthetic appearances.
After a tooth extraction, the bone will shrink in width and height overtime. Inorder to preserve the bone, a socket augmentation bonegraft procedure is completed. This allows the bone preservation and for future implants to be placed.
Like all sinus cavities, the maxillary sinuses behind your cheek and on top of your upper teeth are like empty rooms. Removing the upper teeth causes the sinus to expand, leaving a thin wall of bone separating the maxillary sinus floor to the alveolar crest. Without a more substantial bone structure, dental implants won’t hold in place.
A sinus graft or sinus lift graft involves a dental implant surgeon entering the sinus formerly occupied by the upper teeth. After lifting the sinus membrane upward, the surgeon then inserts the donor bone into the sinus floor in the roof of the upper jaw. It will take 4 to 8 months of healing before the bone assimilates into the natural jaw structure solidly enough to insert and stabilize dental implants in the new sinus bone.
There are 2 types of sinus lift procedures that can be done depending on how much residual bone remains.
Sinus augmentations and implant placement may require only one procedure if enough bone between the upper jaw ridge and bottom of the sinus remains to stabilize implants. The sinus augmentation may have to be performed first, then the graft allowed several months to mature, depending on how little bone is available and the type of graft material inserted.
Some severe cases in which the jawbone reabsorbs the ridge may require bone-graft placement to increase the ridge’s height and/or width and thicken it enough to place conventional implants.
This technique mechanically expands the jaw’s bony ridge. We can place and mature bone-graft material up to several months before we place the implant.
Occasionally, placing lower-jaw implants where the lower jaw’s two back molars and/or second premolar are missing requires that we move the inferior alveolar nerve. Temporarily shifting this nerve that supplies sensation to the lower lip and chin is a necessarily approach, since patients almost always experience degrees of postoperative lower-lip and jaw numbness that dissipates slowly (if ever), and will usually only be considered if less aggressive options such as blade implants are not viable.
These surgeries are performed in the out-office surgical suite under oral sedation, nitrous oxide sedation or general anesthesia. After discharge, we recommend one full day of bed rest and limiting physical activity for at least one week.
We typically begin the bone-grafting process by removing an outer section of the cheek-side of the lower jawbone. This exposes the nerve and vessel canal bundle so that we can pull it slightly out to the side to track its activity while placing the implants. Finally, we close the area after refilling it with the surgeon’s choice of bone-graft material.
Depending on the patient’s condition, we may perform these procedures either separately or together and with grafts from any of several sites. Bone grafts from inside the mouth – specifically, from the chin or the upper jaw’s third-molar region behind the last tooth – frequently prove suitable for maxillofacial-region grafts. Where more extensive grafts are needed, the surgeon may elect to harvest a larger graft from the hip or outer aspect of the tibia.
Regardless of the site, grafts from the patient’s own bone generally offer the most successful results.
We often implement bone grafting by applying allograft materials prepared from cadavers. These materials are used effectively and safely to get the patient’s own bone to grow suitably into the repair site. Synthetic materials and factors from the patient’s own blood can also often successfully stimulate bone formation at graft sites.
Typically, major bone grafts repair jaw defects that follow traumatic injuries, tumor surgery or congenital defects – usually using the patient’s own bone. Depending on the defect’s size, a doctor may harvest the bone surgically from one of several sites, including the skull, hip or lateral knee (tibia). Since this stage in the process is routinely performed in an operating room, this step will require a hospital stay.