Over a period of time, the bone in the lower jaw (mandible) and upper jaw (maxilla) will resorb or diminish if a tooth is missing or affected by an infection such as an abscess or periodontal disease. This creates a condition in which there is poor quantity and/or quality of bone suitable for dental implant placement. To build back the bone, which is necessary for a dental implant, we use several bone grafting techniques. Not only does this allow us the opportunity to place implants of proper width and length, it also gives our oral and maxillofacial surgeons a chance to restore the tooth to both its original function and aesthetic appearance. Studies also show a longer lifespan of the implant and better aesthetics with adequate bone support. We have been using the following bone grafting procedures, along with the latest bone grafting technology, at Loudoun Oral and Maxillofacial Surgery with great success.
The Socket Preservation Graft
Careful management of the extraction sockets at the time the tooth is removed will prevent unsightly bone loss as well as a better aesthetic result, regardless of whether a tooth is to be replaced with a dental implant or a bridge. The socket preservation graft can help manage the tooth extraction site and is used immediately after one or more teeth have been extracted. After an extraction, some of the soft tissue (gums) and bone around a tooth that has been infected for some time or had periodontal disease is lost. Other extractions are difficult and may require the removal of some bone in order to extract the entire tooth, or the bone is very thin to start with. When necessary, to avoid collapse of the socket (up to 60% loss of bone width in the first year after extraction) bone is placed into the socket at the time of extraction. This grafted bone will augment the site to its natural and original state. The bone, in the form of particles, is obtained from a bone bank. This bone is placed into the site of the extraction and then we will place and secure a dissolvable barrier to the oral environment. Not only will this technique augment the tissue, it will also preserve the normal contours of the soft tissue and bone. We have found that socket preservation grafts offer greater success for the future implant since the normal architecture of soft tissues and bone have been preserved to a greater extent. In addition, the amount of surgery time and need for further grafting is minimized. The implant can also be placed in a more natural position, facilitating the best possible functional and aesthetic result.
Block Bone Grafts
Sometimes, the height and width of bone are insufficient to place an implant properly. In this case, we need to augment the bone. To do this, we will frequently remove bone from the third molar area and place it in the area that needs to be augmented. Your own bone (autogenous bone) is the best type of bone to use in the areas of the jaw that require greater thickness. This block graft is secured in place with small screws and the graft is allowed to fuse to the natural bone for approximately four to five months. At the time the implant is placed, the small screws will be removed. Our doctors have found that by using the patient’s own bone, the implant will be more secure and less time will be needed before the crown attached to the implant.
Sinus Lift Bone Grafting Technique
This is a very common procedure designed to provide bone for implants in the back of the upper jaw. First, a small window is made under the tissue on the side of the upper jaw to expose the maxillary sinus. The membrane lining of the sinus is elevated and the bone graft material is placed under the membrane. The tissue is then closed over the window and allowed to heal. Over the next six months, the bone graft material will form new bone. After that time, dental implants are placed in their position for the attachment of future crowns.
Sometimes there is enough bone present to stabilize the implant, but not enough for actual long-term function. In this case, a dental implant can be placed at the time of sinus grafting, allowing for a shortened time before the restoration and function of your new tooth.
Guided Bone Regeneration
Guided tissue regeneration is used when the bone has a localized defect or the bone in the desired implant area is only slightly inadequate. Guided tissue regeneration allows us to grow the necessary bone in an area to facilitate proper placement of the implant. Most often, banked bone will be used alone or in combination with your own bone to provide volume for the graft. This bone material is then covered with a barrier membrane which allows nutrients necessary for healing to gain access to the area but denies access to gum tissue cells that would hinder healing. Over a period of about four months, the graft bone is then turned into your own bone in this area.
For larger defects that don’t require a block graft (see above) another technique is used which can augment and hold a larger volume of graft material. The sonic weld technique involves using a resorbable membrane or “foil” which is ultrasonically “welded” to pins which are placed in the area requiring augmentation. The unique feature of this system is that it allows the area to be grafted with a larger volume of bone while better holding the shape of the grafted bone. The increased rigidity increases the predictability of regenerating the desired bone volume. The pins and membrane resorb and disappear over time, which eliminates the need to remove them at a later date.
PRGF stands for plasma rich in growth factors. This technology essentially lets you to help yourself heal using concentrated components in your blood that are a normal part of wound healing. Blood is drawn just prior to beginning the procedure and is processed to concentrate the healing factors in your blood that promote blood vessel, bone and tissue growth. These factors are incorporated into the graft material and are also used in the grafted site to facilitate healing. Using PRGF as an adjunct to bone grafting, we have found improved healing, a more comfortable recovery, and larger retention of volume in the grafted sites.
Soft Tissue Grafting Procedures
Both implants and natural teeth are best maintained when there is healthy gum tissue to surround them. In the past, poor gum tissues were considered untreatable and were often blamed as the cause for the failure of complicated dental treatments and restorations.
Today Dr. Bluhm, Dr. Dorsch, and Dr. Vandervort utilize some of the most advanced techniques and technologies to reconstruct the gum tissue surrounding your dental implants. These techniques are both functional (improving the ease of cleaning the implant) and cosmetic (allowing for natural-looking restorations with good color and shape). Having healthy gum tissue around implants and natural teeth helps maintain esthetics and helps avoid early recession defects.
Periodontal reconstructive and plastic surgery, depending on your individual needs, may involve a procedure as simple as minor re-contouring of your gums or as complex as multi-staged grafting surgeries. Dr. Dorsch, Dr. Bluhm, and Dr. Vandervort will be glad to discuss your individual treatment needs with you during your consultation at Loudoun Oral and Maxillofacial Surgery.
These periodontal surgeries are performed in our out-patient surgical suite under local anesthesia or IV sedation. Your anesthetic options will be discussed with you during your consultation.