Major and Minor Bone Grafting

When you have been missing teeth for quite some time, the jawbone begins to shrink making it difficult to place a dental implant. In the past if a patient lacked bone then they would not be suited for dental implants,  However with the advancement of technology it is now possible to stimulate the development of bone where it is required which enables us to proceed with the implant process.

Major Bone Grafting

We usually carry out the placement of major grafting material to restore deformities of the jaw, which can be caused by severe injuries, tumor operation, or birth defects. If the defects are extensive, we normally remove a piece of bone from a patient’s body – such as the skull, hip, or knee and transplant to where it is needed.  Bone grafting is often done in a surgical environment and may require a hospital stay.

The Relevance of Teeth for Jawbone Health

If one or several of your teeth are missing, your jawbone can start to deteriorate; This deterioration can lead to other problems such as collapsed facial profile, difficulty in speaking and poor overall health. Your remaining teeth may also fail to function properly and therefore give you even more problems.

Just as exercise is needed to ensure the body muscles work properly, the bone tissues also need to be used to prevent deterioration. Your natural teeth are implanted in the jawbone. As such, they stimulate the jawbone to develop by means of actions such as chewing and biting. If you have lost one or several of your teeth, the alveolar bone, or the part of the jawbone that secures the teeth into the mouth, stops receiving the needed stimulation and begins to deteriorate.

Potential Outcomes of Teeth and Jawbone Loss

  • Difficulties in effectively using the remaining teeth
  • Altered facial appearance
  • Inadequate lip support
  • Skin wrinkling in the regions around the mouth
  • Jaw (TMJ or temporomandibular joint) pain, facial pain, and headaches
  • Impaired speech
  • Deterioration of health due to the inability to eat food properly
  • Sinus expansion

Causes of Jawbone Loss and Degeneration

Here are the most widespread reasons for the occurrence of jawbone degeneration and loss. If this condition occurs, it may necessitate the placement of bone grafting material.

1. Teeth removal

If the teeth of an adult are extracted and not restored, the degradation of the jawbone normally ensues. The pace of bone loss differs from one patient to the other. Nonetheless, most loss usually takes place during the initial 18 months after teeth removal and will go on bit by bit throughout the lifetime of the patient.

2. Periodontal Diseases

Periodontal diseases or gum diseases are infections that gradually affect the tooth-supporting structures (for example, alveolar bone, periodontal ligament, cementum, and gingiva). There are several infections and inflammations that normally destroy the support and surrounding of the natural teeth. The most prevalent types are the plaque-induced inflammatory lesions, which can either be gingivitis or periodontitis. In most people, if gingivitis is not treated in time, it may advance into periodontitis.

Gingivitis mainly results from dental plaque. Plaque is a viscous, colorless material that contains bacteria, which forms mostly from food particles left in the mouth. The bacteria present in plaque generate poisonous substances that inflame the gums.  They become red, swollen, sore, and bleed easily when brushing your teeth.  When this irritation continues for some time, the gums will pull away from the teeth, leading to the establishment of small spaces between the gum and teeth. If you do not practice good oral hygiene, plaque can strengthen into a coarse, porous material referred to as calculus or tartar. This substance can form both over and beneath the gum line.

When gingivitis advances into periodontitis, it can cause the tooth-supporting structures to weaken. Consequently, this can lead to your teeth loosening and ultimately falling out.

3. Dentures/Bridgework

Unfastened dentures are inserted on top the gum line to replace the missing teeth. However, since these dentures depend on the bone to keep them into position, they do not give the necessary stimulation for the underlying alveolar bone. As a result, they cause the bone to deteriorate gradually. Ultimately, bone degeneration may increase to a level that dentures can no longer be kept into position. When this occurs, placement of new dentures will be needed.

On the other hand, some dentures are fastened into position using anchors. And, this assists in sufficiently stimulating and protecting the bone from deterioration.

If bridgework is used to replace missing teeth, the underlying alveolar bone will receive adequate stimulation from the teeth on both sides of the device. However, the section of the bridge that covers the gap where the teeth are lost does not get any stimulation. As a result, bone loss can take place in this region.

4. Trauma

If your tooth is missing or is broken such that the biting surface below the gum line is no longer available, then the underlying bone will not be stimulated. Over time, this leads to jawbone loss.

Here are some common types of tooth and jawbone trauma.

  • Teeth lost due to injury or accident
  • Jaw fractures
  • Teeth with a history of trauma that may die and result in bone deterioration years following the first trauma

5. Misalignment

Misalignment occurs when the upper and lower teeth are not able to fit together properly when grinding and chewing. The teeth that are not aligned properly can over-erupt, leading to bone loss.

Problems such as TMJ (temporomandibular joint)disorders, normal wear and tear, and absence of treatment can produce abnormal physical forces that can cause the upper and the lower jaw not to be in the right relationship with one another. Gradually, bone loss can take place where the bone is not getting sufficient simulation.

6. Osteomyelitis

Osteomyelitis (sometimes abbreviated to OM) is an uncommon but serious bacterial infection of the bone or bone marrow of the jawbone. Osteomyelitis can result in inflammation, which can impair the steady supply of blood to the bone. This condition is normally treated using antibiotics as well as taking the affected bone out of the body. A bone graft procedure may be necessary to ensure the remaining bone functions and develops optimally.

7. Tumors

Benign facial tumors may increase in size and become uncomfortable such that the affected section of the jaw needs to be taken out. Malignant mouth tumors usually enlarge into the jaw, necessitating the part of the jaw to be taken out. In both instances, reconstructive bone grafting is normally done to ensure the jaw continues to work well and without any difficulties. Performing a bone grafting procedure in individuals affected by malignant tumors may be more demanding since treatment of the cancerous tumor usually involves taking away the adjacent soft tissues, as well.

8. Developmental Deformities

Various conditions or syndromes are typified by losing sections of the teeth and other areas of the face.

9. Sinus Deficiencies

If molars are taken out from the upper jaw, air pressure originating from the air cavity in the maxilla (maxillary sinus) often results in resorption of the bone that previously assisted in securing the teeth into position. Because of this, the sinus usually increases in size. This condition is referred to as hyperpneumatized sinus.

The hyperpneumatized sinus normally takes years to develop and may lead to inadequate bone strength and quality needed for the placement of implant supported teeth restorations. In this case we carry out a procedure referred to as “sinus lift” to correct the condition.

Bone Grafting Overview

For a brief narrated overview of the bone grafting process, please click the image below. It will launch our educational MiniModule in a separate window that may answer some of your questions about bone grafting.

Bone Grafting Overview

Types of Bone Grafts

1. Autogenous bone grafts

These refer to the bone taken from one part of your body and transplanted to where it is required. The autogenous grafting materials, also referred to as autografts, are normally removed from the chin area, jawbone, bone in the leg, hip, or the cranium. Autografts are normally preferred for bone grafting because they have great fusion rates. Furthermore, autografts eliminate the risk of the patient rejecting the graft substance because the patient’s own bone is used for the procedure.

On the other hand, one main disadvantage of autogenous grafts is that they require another procedure to remove the graft material from a different place in the patient’s body. Dr. Dhadli will recommend whether this is necessary after analyzing your condition.

2. Allogenic Bone

Allogenic bone, or allograft, just like autografts, is harvested from humans; the disparity is that the former is taken from a person other than the recipient of the graft material. Allogenic bone is the dead bone collected from cadavers who have given their bone to be used by patients who require it; it is normally taken from a tissue bank.

Another difference between an allogenic graft and an autogenous graft is that the former cannot generate a new bone by itself. Instead, it functions as a fabric, or scaffold, on which bone from adjacent bony areas can develop and seal the empty space.

3. Xenogenic Bone

This type of bone grafts is taken from species other than human, normally a cow.  To reduce the chances of allergic reactions and transfer of diseases, the bone is normally heated at very high temperatures. Similar to allografts, xenogenic grafts function as a fabric to support the development of the bone from the neighboring areas.

In contrast to autogenous bone grafts, both allografts and xenogenic grafts do not need another procedure to remove bone from elsewhere in the body. However, since these types of bone grafts have less fusion rates, bone reconstruction may require an extended period of time than with the autogenous bone grafts.

Bone Graft Substitutes

Several synthetic products have been created and they can be comfortably used as alternatives for using real bone. Here are some of them.

1. Demineralized Bone Matrix (DBM)/Demineralized Freeze-Dried Bone Allograft (DFDBA)

This synthetic material is an extensively processed allogenic bone. It has collagen, proteins and other growth elements removed from the allogenic bone. DBM/DFDBA is usually found in the form of fine particles, putty, chips, or as a gel. As such, it can be safely injected into the body using a syringe.

2.   Graft Composites

This type of bone graft substitute utilizes the combination of other bone grafting materials and various growth elements to realize the advantages of a wide assortment of substances. For example, some composites may consist of collagen/ceramic materials that have nearly the same makeup as the natural bone.

3. Bone Morphogenetic Proteins (BMPs)

These multi-functional growth factors naturally induce bone development and healing in our bodies. These proteins are able to accelerate the rate of bone growth and also limit the risks of rejection by the recipient.

Just like allografts and xenogenic grafts, synthetic bone graft substances do not need a second procedure to extract the bone. Therefore, this greatly reduces the risk and pain to the patients.

It is important to mention that each bone grafting procedure has its own risks and advantages. At Westside OMS, we will examine your condition before recommending the most appropriate bone grafting option suitable for your specific case.

Ridge Augmentation

What is Ridge Augmentation?

Ridge Augmentation is a common surgical procedure usually carried out after the removal of teeth. This process helps to rebuild the natural shape of the gums and jaw that may have been lost because of removal of teeth, periodontal disease, wearing dentures, or any other reason.

The alveolar ridges that form the edges of the upper and lower jaws are the ones responsible for supporting the teeth. Since they contain the sockets of the teeth, an empty space is normally left after a tooth has been extracted. In most cases, the empty space will heal by itself. The socket is often naturally filled with bone and tissue after tooth extraction. However, at times, this fails to happen and the original height and width of the socket is destroyed.

As such, it may be essential to reconstruct the shape of the alveolar ridge to assure a successful implant procedure.  Therefore, performing a ridge augmentation procedure can assist in reconstructing the bone such that the implants are properly supported.

How the Ridge Augmentation Procedure is Done

It is usually done through inserting a bone graft substance in the empty tooth socket left after the tooth has been extracted. Ridge augmentation is normally carried out immediately after tooth extraction has taken place. Thereafter, the gum tissue is put over the socket and stitched into position. Depending on your condition, we may use a space-maintaining material on top of the graft to stimulate the development of the new bone..

We usually carry out the procedure for reconstructing the shape of the alveolar ridge at our office in Hillsboro, Oregon, using local anesthesia. We may use sedative medication depending on the needs of the patients. 

Preserving Your Jawbone After Tooth Removal

Extraction of your teeth can be a good option if you are experiencing discomfort, infection, bone deterioration, or because of an injury in the tooth. The bone that anchors the tooth in position (the socket) is usually destroyed because of disease and/or infection, leading in the malfunctioning of the jaw once the tooth has been removed. Furthermore, if you have had teeth removed, you can end up with a distorted facial appearance.

These deformities of the jaw can lead to several difficulties in effectively completing restorative dentistry irrespective of the type of teeth replacement option you have chosen. Jaw defects arising from extraction of teeth can be avoided and fixed through using a procedure referred to as socket preservation. Socket preservation can significantly restore the aesthetics to your smile and increase the possibility for the success of implant supported teeth restorations.

Numerous methods are available for preserving the bone and limiting bone deterioration following tooth removal. For example, one well-known technique involves stuffing the socket with bone or bone substitute after the tooth has been extracted. Then it is wrapped with gum, synthetic membrane, or tissue to stimulate the body to reconstruct the socket on its own. Using this technique enables the socket to heal. The freshly created bone in the socket also gives sufficient footing for the placement of the dental implants.