Bone Grafting

Bone Grafting Explained:

digital illustration of the bone grafting process

Whenever a patient loses a tooth, the jawbone associated with the missing tooth shrinks. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants without a bone graft.

Today, we can grow bone where needed. This not only allows us to place implants of proper length and width, but it also gives us a chance to restore functionality and aesthetic appearance.

What are Some Potential Consequences of Tooth and Jawbone Loss? 

  • Problems with remaining teeth, including, misalignment, drifting, loosening and loss
  • Collapsed facial profile
  • Limited lip support
  • Skin wrinkling around the mouth
  • Distortion of other facial features
  • Jaw (temporomandibular joint [TMJ]) pain, facial pain, and headaches
  • Difficulty speaking and communicating
  • Inadequate nutrition as a result of the inability to chew properly and painlessly
  • Sinus expansion

The Beauty in Bone Regeneration 

Bone grafting can repair dental implant sites with inadequate bone structure due to previous extractions, gum disease, or injuries. The bone is either obtained from a tissue bank or your own bone is 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 or guided tissue regeneration.

Types of Bone Grafts:

Autogenous Bone Grafts: Made from your own bone, typically harvested from various body areas. Contains living elements that aid bone growth. Requires a second procedure for harvesting.

  • Allogenic Bone: Dead bone from a cadaver processed to remove water. Serves as a scaffold for surrounding bone growth but cannot produce new bone independently.
  • Demineralized Bone Matrix (DBM)/Demineralized Freeze-Dried Bone Allograft (DFDBA): Processed allograft bone containing collagen, proteins, and growth factors. Available in various forms.
  • Xenogenic Bone: Derived from non-living bone of another species, usually bovine. Serves as a framework for bone growth.

Bone Graft Substitutes: Synthetic materials offer safe alternatives to real bone:

  • Graft Composites: Mixtures of various bone graft materials and growth factors to mimic natural bone composition.
  • Bone Morphogenetic Proteins (BMPs): Naturally occurring proteins that promote bone formation and healing.

Synthetic materials avoid the need for a second bone harvesting procedure. Each option has its own risks and benefits, to be determined by your dental professionals.

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Reasons for Jawbone Loss and Deterioration

The following are the most common causes for jawbone deterioration and loss that may require a bone grafting procedure:

Tooth Extractions: When an adult tooth is extracted and not replaced, it can lead to jawbone deterioration. Natural teeth stimulate the jawbone through activities like chewing and biting. Without this stimulation, the alveolar bone, which anchors teeth, starts to break down. This process, called resorption, happens at different rates for each person. Most bone loss occurs within the first eighteen months after extraction and continues over time

right side of the patient's mouth
left side of the patient's dentition

Look at the two photos above. The left photo shows the right side of the patient dentition. The right photo shows the left side of the patient dentition. The patient lost three teeth just a couple of years before the photo was taken . Look at the amount of bone that was lost!

Periodontal Disease: When an adult tooth is extracted and not replaced, it can lead to jawbone deterioration. Natural teeth stimulate the jawbone through activities like chewing and biting. Without this stimulation, the alveolar bone starts to break down. This process, called resorption, varies in rate among individuals, with most bone loss occurring within the first eighteen months after extraction and continuing over time.

Dentures/Bridgework: Unanchored dentures, placed on the gum line, lack direct stimulation to the underlying alveolar bone. This absence of stimulation leads to bone resorption and deterioration over time. Consequently, denture wearers may face issues like loosening, difficulty eating, and speaking. Severe bone loss may necessitate new dentures, even with strong adhesives. Proper denture care, repair, and refitting are crucial for oral health maintenance.

severe atrophic ridges due to loss of function and wear of removable dentures

Look at the photo , it shows severe atrophic ridges due to loss of function and wear of removable dentures.

Some dentures are supported by anchors, which do help adequately stimulate, and therefore preserve bone.

With bridgework, the teeth on either side of the appliance provide sufficient stimulation to the bone, but the portion of the bridge that spans the gap where the teeth are missing receives no direct stimulation. Bone loss can occur in this area.
By completing a bone graft procedure, Dr. Gallez, Dr. Sanz Miralles and Dr. Ha are now able to restore bone function and growth, thereby halting the effects of poor denture care.

the patient lost his central incisor due to traumaTrauma: When a tooth is knocked out or broken to the extent that no biting surface is left below the gum line, bone stimulation stops, which results in jaw bone loss. Some common forms of tooth and jaw trauma include: teeth knocked out from injury or accident, jaw fractures, or teeth with a history of trauma that may die and lead to bone loss years after the initial trauma.

A bone grafting procedure would be necessary to reverse the effects of bone deterioration, restoring function and promoting new bone growth in traumatized areas.

In this case on the left, the patient lost his central incisor due to trauma. Look at the concavity of the ridge.

Misalignment: Misalignment issues can create a situation in the mouth where some teeth no longer have an opposing tooth structure. The unopposed tooth can over-erupt, causing deterioration of the underlying bone.

Issues such as TMJ problems, normal wear-and-tear, and lack of treatment can also create abnormal physical forces that interfere with the teeth’s ability to grind and chew properly. Over time, bone deterioration can occur where bone is losing stimulation.

Tumors: Benign facial tumors, though generally non-threateningly, may grow large and require removal of a portion of the jaw. Malignant mouth tumors almost always spread into the jaw, requiring removal of a section of the jaw. In both cases, reconstructive bone grafting is usually required to help restore function to the jaw. Grafting in patients with malignant tumors may be more challenging because treatment of the cancerous tumor generally requires removal of surrounding soft tissue as well.

Sinus Deficiencies: When molars are removed from the upper jaw, air pressure from the air cavity in the maxilla (maxillary sinus), causes resorption of the bone that formerly helped the teeth in place. As a result, the sinuses become enlarged, a condition called hyperpneumatized sinus.

This condition usually develops over several years, and may result in insufficient bone fro the placement of dental implants. Drs. Gallez, Sanz Miralles and Ha can perform a procedure called a “sinus lift” that can treat enlarged sinuses.

What will the Procedure Be Like? 

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 patient’s 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 require a hospital stay.