Dental implants are now the most preferred tooth replacement option among dentists as well as among patients. However, along with this exponential increase in the use of dental implants, the failure of dental implants is also on the rise.
Due to this, most dentists are now focusing on the techniques and means to improve their dental implant success rate. Bone grafting is one technique that can be used to increase the success rate of dental implants.
Why you need bone grafts for dental implants
As soon as you lose one or more teeth, the alveolar bone ridge (the bone holding your teeth) begins to get reabsorbed. On average, within 12 months of tooth loss, around 25% of the underlying bone gets reabsorbed in your body and disappears. This means that the longer you wait to get dental implants after your tooth loss, the more likely it is that your bone would have shrunk considerably and can no longer support the dental implants.
However, this does not mean that you cannot get a dental implant. If your supporting bone is too thin, too soft, or too short, you can go through a bone graft to support the dental implant. Apart from reabsorption of the bone, other factors that require bone grafting include the presence of bony defects due to trauma or infection and the need to place implants in strategic sites for functional and aesthetic success.
The typical bone grafting procedure
For your bone graft, your periodontist will typically use bone sourced from your own body. This bone can typically be from your back, lower jaw, hip, chin, or shin. However, in some cases, processed bone graft material from cadavers, cows, or horses can be used. Your dentist can also use synthetic bone grafts too, there are plenty of options.
Your periodontist will first take a CT scan of the site where the bone graft has to be placed. They will then put you under sedation and administer a local anaesthetic. A block of bone will be positioned and anchored with miniature titanium screws. This is then surrounded by loose bone graft materials. The bone will fuse and grow together and all non-bone cells will turn into bone cells in the weeks and months ahead.
Minor bone grafting can also be carried out on the same day that the implant is placed. However, most bone grafts take about 4 to 6 months to form completely and to be ready for dental implant placement. A successful bone graft can add about 30% more bone to the area.
The timing of the placement of dental implants will depend on the location of the graft and the density of the bone. When necessary and appropriate, temporary teeth, such as a bridge or a denture can be worn while waiting for the bone graft to “take hold” so you do not have a gap in your teeth while waiting.
Other types of bone grafts
While we have talked about the typical bone graft surgery for a dental implant, there are other types of bone grafts that are done in specific situations. Some of these are:
•Sinus lifts: This is carried out when not enough bone exists in the back upper jaw for implants. Due to this, the bone may need to be grafted on to increase its height. During this process, the maxillary sinus will be raised slightly to make room for the extra bone being added.
•Ridge expansion: This can widen your jawbone’s alveolar ridge if the latter is too thin. Your dentist will use a specialized dental saw to cut along the top of the alveolar bridge. After this, the “canal” that is created is filled with bone grafting material. The implants can be placed immediately or your periodontist can wait several months while your jawbone heals.
•Bone augmentation: This procedure is used when the bone is too short. It will be gradually grown in any direction rather than simply using a full-fledged bone graft. A piece of bone is secured to the bone that needs to be extended, widened, or made taller.
Requirements for an ideal bone graft
For the bone graft to be successful, the following need to be present:
1.Osteoblasts must be present at the site: Osteoblasts create new bone. For the bone graft to be successful, the graft matrix must contain or encourage population by osteoblasts. If there are an insufficient number of osteoblasts, the graft will fail.
2.Blood supply must be sufficient for nourishment: A bone graft does not repair, it is regeneration. The latter implies that it is a biologic process where not only the tissue but also its form and function is regained. This requires a good blood supply to the graft as well as to the surrounding tissue. Blood is needed for clot formation and for cell viability. The clot serves as the initial matrix where the cells migrate and then serve as anchors for the osteoblasts.
3.The graft must be stabilized during healing: Disruption of the blood clot can occur during healing due to mechanical stresses on the graft. This movement can cause fibrous tissue to fill the defect instead of bone. This is a form of repair and is not true regeneration. Your periodontist may use fixation devices, like guided bone regeneration (GBR), collagen membranes, a titanium mesh, and bone screws.
4.The soft tissue must not be under any tension: Bone is the slowest-growing tissue. GBR is based on the separation of the bone grafted site from the surrounding soft tissue. The GBR membrane keeps the faster-growing tissues, such as epithelium, fibrous tissue, or gingival connective tissue out of the defect. This allows controlled regeneration with vital bone formation to take place. The growth of bone graft material into the defect prevents the collapse of the collagen membrane. It also acts as a placeholder for new regenerating bone and a scaffold for the growth of blood vessels and osteoblasts.
As the bone grafting procedure requires immense skill, it is imperative that you consult the right dentist and periodontist for your bone grafting surgery. At Harbour Pointe Oral Maxillofacial & Advanced Implant Surgery, we are extremely skilled in carrying out bone grafting.
We will work closely with you right from the first consult to determine the type of bone graft that will work best for you. We will also ensure that the entire process before, during, and after your bone graft surgery is as painless and seamless as possible.
We are not only extremely skilled but are also extremely empathetic and we treat all our patients holistically and not just as another dental case. So, if you are looking to get bone grafting surgery done, do consult with us at Harbour Pointe and rest easy, knowing that you have made the best possible choice!
For more information about bone grafting and other dental procedures and solutions, consult Dr Brian Hart and Dr. Kathleen Isdith at 425-353-1009 or at hporalsurgery@gmail.com or go to our website https://www.harbourpointeoralsurgery.net for more information.