Major and Minor bone grafting
Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. 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.
Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants
of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.
Major Bone Grafting
Bone grafting can repair 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.
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 he 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.
Sinus Lift Procedure
The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that
have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these
upper teeth are removed, there is often just 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 it’s called a sinus graft or sinus lift graft. The dental implant surgeon enters the
sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted
into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several
months of healing, the bone becomes part of the patient’s 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
well, 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
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.
Nerve - repositioning
The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved 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 dissipates only very slowly, if ever),
usually other, less aggressive options are considered first (placement of blade implants, etc.)
Typically, we remove an outer section of the cheek side of the lower jawbone in order to expose the nerve and
vessel canal. Then we isolate the nerve and vessel bundle in that area, and slightly pull it out to the side. At
the same time we place the implants we’ll be tracking the neuro-vascular bundle. Then the bundle is released and
placed back over the implants. The surgical access is refilled with bone graft material of the surgeon’s 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 third molar region 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 patient’s own bone for repairs or addition, we
generally get the best results.
In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is
prepared from cadavers and used to get the patients own bone to grow into the repair site. It is quite effective
and very safe. Synthetic materials can also be sued to stimulate bone formation. We even use factors from your own
blood to accelerate and promote bone formation in graft areas.
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.
There are some cases where bone is needed where a completely synthetic product can be substituted instead of
taking the patient's own bone. The product is called INFUSE and is manufactured by Medtronics and is the latest
addition to the surgical options in patients with deficient bone. The product is the exact chemical protein that
triggers bone formation in humans. The protein is rhBMP-2 (recombinant human bone morphogenetic protein 2) in a pure, freeze-dried powder
form. This is a naturally occurring protein common to all humans and animals with bone that is found in very
small amounts, and its purpose is to stimulate bone formation at the site in which it's placed. The natural
carrier of the protein is an absorbable collagen sponge (ACS), which is made from a material found in bone and
tendons. The ACS releases the protein over time in the location where it is placed, and provides a scaffold on
which new bone can grow. As the graft site heals, the ACS is absorbed and replaced by bone. The advantage of
using this product is offers the patient another choice in bone grafting. Patient that are candidates for
INFUSE, can choose this method of grafting thus avoiding having to have their own bone harvest from another spot
in their mouth or body.
For more information on this product, please see: https://www.infusebonegraft.com/omf_index.html.
Dr. Bohannan is proud to introduce this new technology to his patients. Bone surgery has become much easier
thanks to new technology. Utilizing modulated ultrasound, this surgical unit called "the piezosurgery unit"
vibrates and cuts the bone but minimizes damage to soft tissues (gums, cheeks, but more importantly sinus
membranes, nerves and blood vessels). Thanks to its controlled
three-dimensional ultrasound oscillations, the Piezosurgery technique rings in a new age for osteotomy and
osteoplasty in Implantology, Periodontology, Endodontics and Orthodontic Surgery. Its main features
cutting: Maximum surgical precision and intra-operative
cutting: Maximum safety for the soft
- Cavitation effect: Maximum intra-operative
visibility (bloodless field). More information about this device see this site.
To schedule an appointment, click
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