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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 were 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.

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 (artificial bone for minor defects) 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.


Large defects of the face and jaws are repaired using the patient’s own bone.  Major bone grafts are typically performed to repair these defects.  They may arise as a result of traumatic injuries, tumor surgery, or congenital defects. 

The bone is harvested from a number of different sites depending on the size of the defect.  The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites.  These procedures are routinely performed in the office or the operating room.

Ridge Expansion

In severe cases, the ridge (area where the teeth were) 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.)

     
 

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 placed.

 
     

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 will place the implants.  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.

     
 

The Surgical Procedure

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, 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 promote the patients own bone to grow into the repair site.  It is quite effective and very safe.  Synthetic materials can also be used 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.

 
     

Periodontal Plastic and Reconstructive Surgery

Both teeth and implants are best maintained when they are in healthy gum tissues. In the past, poor gums were considered untreatable and were blamed as the cause for the failure of complicated dental restorations.

Today, Dr Matouk and Dr. Sperling  use the most advanced techniques to reconstruct the periodontal and gingival tissues. These techniques are both functional (improve cleansability and reduce sensitivity of exposed roots) and cosmetic (allow for natural appearing restorations with good shape and color).

Periodontal plastic and reconstructive surgery may involve procedures as simple as the minor recontouring of your gums or as complex as multi-staged grafting operations. Dr Matouk or Dr. Sperling will be glad to discuss with you your individual needs.

These surgeries are performed in the out-office surgical suite under I.V. sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.