Periodontic Bone Grafting
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Edward Brant, DDS, MS
Periodontist Specialist
Bone - Tissue Graft Procedures
447 Lake Avenue
Saint James, NY 11780
(631) 584-4395

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Jawbone Augmentation: Reconstructive Bone Grafting

Severe Resorption Mandibular Jawbone
Mandibular Bone Loss
Severe Example

The Basics of Bone Grafts

Age Specific?

The science of bone augmentation in dentistry and all of its intricacies usually becomes a topic of intense interest to older adults.

Multiple losses of teeth and the increasing incidence of gingivitis and periodontitis is somewhat cumulative and affects older populations rather than younger.

Unusual conditions can occur at younger ages that might be associated with birth defects (missing incisors - a common disorder), inadequate orthodontic treatments, developmentally malformed upper and lower jaw relationships, the classic cleft palate ..... and perhaps the most common ... untreated tooth extractions that can create the need for a bone graft procedure.

Too much resorbing bone
Catastrophic Bone Loss
Gum Disease

The Graft Procedure No One Gets

Theoretically ... all of us, who have had an extraction here... an extraction there.. starting around those ages where adult teeth are being removed (usually for convenience or financial reasons) may be setting the stage for future bone loss issues that we don't focus on until later years.

Socket grafts are perhaps one of the simplest bone graft treatments that researchers recommend for common and seemingly simple adult tooth extraction. More and more research shows that untreated extractions will initiate bone loss in the immediate extraction site but can threaten adjacent bone supporting other nearby teeth.

Resorption
Poor Oral Health Habits
Excessive Untreated Extractions

Common Grafting Procedures

Reconstructive dentists whose practices are heavily focused on a variety of tooth replacement technologies typically have a variety of hard tissue (bone) augmentation products that can successfully treat individual areas or larger expanses of a jawbone arch.

The jawbone graft type and the procedure used for a particular graft treatment is determined by the location of depleted bone, amount lost and the remaining tissue health. Like many other complex dental treatments... there is no "one size fits all" concept.. and the greater access to advanced technology hybrids (special applications) the more successful the outcome.

Types of Bone Grafting Materials

  • Autogenous Bone: Provided by the patient, self donated. It can be harvested from the lower jaw, illiac crest, calvarium (skull), rib and tibia. Although autogenous grafts are considered the "gold standard" of grafting, it involves an additional surgical site. Chin block grafts are becoming a popular and extremely successful treatment.

  • Allograft Products: Bone products that are derived from humans and provided in the form of demineralized freeze dried bone, irradiated bone, freeze dried bone matrix, human bone ash or fresh frozen bone. Combined with Platelet Rich Plasma (PRP) these materials serve as an excellent graft for sinus lifts and ridge-splitting techniques.

  • Xenografts: Derived from non human species include bovine porcine and are readily available. Compounds for stimulating or accelerating tissue regeneration are often combined with grafting materials, depending on the distributor.

  • Alloplasts: Artificial synthetic bone material that can be made of glass or ceramics. Not used as often as other products mentioned above.

Membrane Grafts

Membranes are commonly used in many hard tissue graft surgeries. Because of the different regenerative properties of hard and soft tissues, they are used to prevent soft tissue from growing into or migrating into the graft material before the bone has a chance to regenerate.

Nonresorbable membranes offer the feature of being able to remain in the graft site for a longer period of time (increases predictability of success) but require an additional surgery to remove the product when it is no longer needed.

Resorbable membranes are probably the most popular and conveniently dissolve by themselves after a few months. There is no residual of the product to remove.

Types of grafting

When bone height or width is a treatment issue, Onlay grafts are commonly used. In some periodontitis treatment cases, chin block grafts (self donated chin bone) or ramus grafts (bone segments removed from posterior area of the lower jaw) are used with great success.

Areas of the chin bone from which bone is extracted are known to regenerate very very quickly and provide what many reconstructive dentists consider to be the healthiest and best source of augmentation material.

Sinus Lifts

Complications involving the sinus tissues often arise from dental treatments associated with the upper arch, especially extractions and/or dental implant procedures. When diagnostic data hint at a possible sinus tissue complication, a routine sinus lift procedure is performed. Grafting materials are moved into the site, which later heals into increased bone height between the sinus cavity and bone area of the planned implant device.

In situations where the implant has already been placed, a surgical point of entry can be made elsewhere, in many cases, to create the needed bone without disturbing the implant. Ideally, maxillary (upper jaw) implant sites should be evaluated closely for possible sinus cavity complications.

Ridge splitting:

Visit our Solutions For No Bone page to learn more about Dr. Brant's use of this advanced bone modification procedure that restores hope for patients who have been told they have no bone left.

Thin ridges that exist on either jawbone, as a result of long term denture use or an extended history of multiple untreated tooth extractions, can be treated with grafting procedures that split the existing bone. Specialized grafting products can then be injected or manually packed into the area of interest with great accuracy.

As the specialized osteotomes (bone splitting tools) are removed, the bony ridge forms a compact seal, thereby producing a desirable environment for healthy bone tissue regeneration. After healing is completed.. the grafted sites can be prepared for the final implant devices.

For some patients, ridge splitting can result in the placement of a dental implant accompanied by grafting material and be fitted with an immediate load temporary restoration.

Block Grafts (Chin Block, Ramus, Hip, Allograft)

Block grafting is an immensely popular procedure for patients who have had extreme bone loss and are fortunate to find a skilled and experience dentist, surgeon, periodontists or implantologist who implements the procedures routinely and confidently.

Healthy blocks of bone that best match the tissue structures of the patient's existing jawbone have the greatest statistical advantage of healing and functioning in a near text-book fashion. Chin and Ramus bone (all within the patient's mouth) is carefully harvested and placed in areas where it is needed the most.

The donor areas rapidly regenerate the excised piece of bone. Since the cellular structure is a near perfect match, osseointegration and the overall progression of reconstruction and eventual placement of implant teeth replacements is uneventful.

Donor sites for bone that are outside of the oral cavity (hip) or are not derived from the patient (allograft) do not possess the same characteristics of chin and ramus bone, therefore imposing a slight degree of risk for final osseointegration.

Since relatively few resources for the various forms of block grafting exists within the same doctor and within any one community, it is not uncommon for patients who are in need of the treatment option... are not aware of it.

Denture patients in particular need to be aware that bone grafting options are almost always available that can restore the cumulative lost dental function due to years and years of denture use.

The Need for Bone Graft Surgery: Summary

  • Preventing / controlling the loss of jawbone after tooth extraction (Socket Grafting/Ridge Preservation)
  • Augmenting the jawbone in preparation for the installation of prosthesis (fixed bridge, implant supported denture)
  • Replacing bone lost to periodontal or gum disease (periodontitis rehabilitation)
  • Bone voids associated with implant placement
  • Replacement of bone lost due to denture use

Questions?

Call our office at (631) 584-4395 to schedule a complimentary consultation or use our on-line Consult Request to learn more about grafting products, technologies and their applications.

Patients who have specific questions about grafting protocols or a suspected graft that is failing are invited to contact Dr. Brant directly with our Ask The Dentist form. Dr. Brant will respond to you directly with the answers or information you are seeking.



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New York Dentist Implants
Suffolk County Long Island
Edward Brant, D.D.S., M.S.
447 Lake Avenue
Long Island Implant Reconstructive Periodontics
St James, NY 11780
Phone: (631) 584-4395 - Fax: (631) 584 - 4398