Bone Grafting

Bone Grafting

Over a period of time, the jawbone associated with missing teeth atrophies or 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 were previousbone1ly not candidates for placement of dental implants.

We now 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. There are a variety of bone grafting procedures which can be done in the office.

Sinus Augmentation (or Lift) procedure

This procedure involves elevating the sinus membrane and placing the bone graft onto the sinus floor. This allows implants to be placed in the back part of the upper jaw when teeth have been removed and bone loss has occurred. The implants can often be placed at the time the grafting is performed.

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Ridge-augmentation with Onlay Grafting

In severe cases the ridge has been reabsorbed and a bone graft is placed to increase the ridge height and/or width. In these situations, the graft is taken from another area inside your mouth. This office procedure is usually performed using general anesthesia and takes about an hour.

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.

These procedures may be performed separately or together, depending upon the individual’s condition. There are several areas of the body which 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.

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.

Jawbone and Extraction Site Preservation

When you need to have a tooth or teeth extracted—whether it be due to decay, abscess, gum disease or injury—it is usually in your best interest to do so in a manner which preserves as much of your underlying jawbone as possible. From the time the teeth are removed, significant degeneration of the surrounding bone begins to take place. You have many options to prevent this, and it is important that you consider them BEFORE any teeth are removed. Some of these procedures are best performed at the time the tooth is removed. Dr. Ladman is an oral and maxillofacial surgeon who specializes in tooth removal, jawbone preservation and dental implant placement.

What happens when a tooth is removed?

There is a special type of bone surrounding your teeth. This bone is called alveolar “ridge” bone, and exists solely to support your teeth. As soon as the tooth is removed, this bone begins to degenerate and “melt away.” This occurs in two dimensions. The first is loss of horizontal width caused by the collapse of the bone surrounding the socket. This makes the remaining ridge narrower than when the tooth was present. The second is a loss of vertical height. This makes the remaining bone less “tall.” This process is faster in areas where you wear a partial or complete denture.

Why is it important to preserve the bone?

You will have several choices of how you can replace the newly missing teeth. All of the options rely on bone support and bone contour for the best function and esthetics. Here is a list of the possible options:

  • You may choose to replace your missing teeth with dental implants. These are root-shaped supports that hold your replacement teeth. The more bone support you have, the stronger the implant replacements will be. In some cases, the bone can degenerate to a point where implants can no longer be placed without having more complex bone grafting procedures to create the necessary support. Obviously, preventing bone loss is much easier than recreating the bone later.
  • You may choose to replace the missing teeth with a “fixed bridge.” This is a restoration that is supported by the teeth adjacent to the missing tooth space. The replacement tooth (or pontic) spans across the space. If the bone is deficient, there will be an unsightly space under the pontic that will trap food and affect your speech.
  • Other replacement alternatives include removable partial or full dentures. These often perform better with more supporting bone.

How can the bone be preserved?

There are two important phases in retaining your alveolar ridge during and after the tooth extraction. Not all extractions are the same—Dr. Ladman will use the most careful techniques to extract the teeth while preserving as much bone as possible. Second—and key to preventing the collapse of the socket—is the addition of bone replacement material to the extraction socket.

There are several types of bone grafting materials and techniques—Dr. Ladman will discuss the most appropriate one with you. After the tooth is extracted, the socket will be packed with a bone-like material and covered with a small absorbable plug or suture. Early on, the grafting material will support the tissue surrounding the socket, and in time will be replaced by new alveolar bone. This bone will be an excellent support should you choose later to have dental implant-supported replacement teeth.

Although the bone created by socket grafting supports and preserves the socket, it will not do so indefinitely. Placing dental implants four to twelve months after the extraction and socket grafting will provide the best long-lasting support for preserving your jawbone and allow you to function as before. Otherwise the graft may “melt away” or resorb over time.

Immediate Dental Implant placement

In some selected cases it is possible to actually extract the tooth and place the dental implant at the same time. We call that immediate implantation. If you are interested in replacing your tooth with an implant and want to be considered for immediate implantation, please call Dr. Ladman’s office for a consultation prior to your extraction.

 

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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.

These procedures may be performed separately or together, depending upon the individual’s condition. There are several areas of the body which 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.

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.

Jawbone and Extraction Site Preservation

When you need to have a tooth or teeth extracted—whether it be due to decay, abscess, gum disease or injury—it is usually in your best interest to do so in a manner which preserves as much of your underlying jawbone as possible. From the time the teeth are removed, significant degeneration of the surrounding bone begins to take place. You have many options to prevent this, and it is important that you consider them BEFORE any teeth are removed. Some of these procedures are best performed at the time the tooth is removed. Dr. Ladman is an oral and maxillofacial surgeon who specializes in tooth removal, jawbone preservation and dental implant placement.

What happens when a tooth is removed?

There is a special type of bone surrounding your teeth. This bone is called alveolar “ridge” bone, and exists solely to support your teeth. As soon as the tooth is removed, this bone begins to degenerate and “melt away.” This occurs in two dimensions. The first is loss of horizontal width caused by the collapse of the bone surrounding the socket. This makes the remaining ridge narrower than when the tooth was present. The second is a loss of vertical height. This makes the remaining bone less “tall.” This process is faster in areas where you wear a partial or complete denture.

Why is it important to preserve the bone?

You will have several choices of how you can replace the newly missing teeth. All of the options rely on bone support and bone contour for the best function and esthetics. Here is a list of the possible options:

  • You may choose to replace your missing teeth with dental implants. These are root-shaped supports that hold your replacement teeth. The more bone support you have, the stronger the implant replacements will be. In some cases, the bone can degenerate to a point where implants can no longer be placed without having more complex bone grafting procedures to create the necessary support. Obviously, preventing bone loss is much easier than recreating the bone later.
  • You may choose to replace the missing teeth with a “fixed bridge.” This is a restoration that is supported by the teeth adjacent to the missing tooth space. The replacement tooth (or pontic) spans across the space. If the bone is deficient, there will be an unsightly space under the pontic that will trap food and affect your speech.
  • Other replacement alternatives include removable partial or full dentures. These often perform better with more supporting bone.

How can the bone be preserved?

There are two important phases in retaining your alveolar ridge during and after the tooth extraction. Not all extractions are the same—Dr. Ladman will use the most careful techniques to extract the teeth while preserving as much bone as possible. Second—and key to preventing the collapse of the socket—is the addition of bone replacement material to the extraction socket.

There are several types of bone grafting materials and techniques—Dr. Ladman will discuss the most appropriate one with you. After the tooth is extracted, the socket will be packed with a bone-like material and covered with a small absorbable plug or suture. Early on, the grafting material will support the tissue surrounding the socket, and in time will be replaced by new alveolar bone. This bone will be an excellent support should you choose later to have dental implant-supported replacement teeth.

Although the bone created by socket grafting supports and preserves the socket, it will not do so indefinitely. Placing dental implants four to twelve months after the extraction and socket grafting will provide the best long-lasting support for preserving your jawbone and allow you to function as before. Otherwise the graft may “melt away” or resorb over time.

Immediate Dental Implant placement

In some selected cases it is possible to actually extract the tooth and place the dental implant at the same time. We call that immediate implantation. If you are interested in replacing your tooth with an implant and want to be considered for immediate implantation, please call Dr. Ladman’s office for a consultation prior to your extraction.