Periodontal disease is the leading cause of bone loss in the oral cavity, though there are others such as ill-fitting dentures and facial trauma. The bone grafting procedure is an excellent way to replace lost bone tissue and encourage natural bone growth. Bone grafting is a versatile and predictable procedure which meets a wide variety of needs.
A bone graft may be required to create a stable base for dental implant placement, to halt the progression of gum disease or to make the smile appear more aesthetically pleasing.
There are several types of dental bone grafts. The following are the most common:
Autogenous bone graft – In this type of graft the bone is removed from elsewhere in the patient's body and implanted in the mouth. Common donor sites for bone grafting include the iliac section of the pelvis, the chin and the posterior third molar areas of the jaw. If large amounts of bone need to be harvested, the hip or the shin bone (tibia) is generally used.
Allograft – Human bone can be obtained from a bone bank (cadaver bone) in many forms. It is clean and effective.
Alloplast - Synthetic bone (man made) can be created in the laboratory and used in the bone grafting procedure.
Xenograft – This is the implantation of bovine (cow) bone. A xenograft is perfectly safe and has been used successfully for many years. Ample bone can be obtained and no secondary donor site is necessary.
Reasons for bone grafting
There are a wide variety of reasons why bone grafting may be the best option for restoring the jaw bone.
Dental implants – Implants are the preferred replacement method for missing teeth because they restore full functionality to the mouth; however, implants need to be firmly anchored in the bone to be effective. If the proposed site lacks the necessary quality or quantity of bone, bone grafting can strengthen and thicken the implant site.
Sinus lift – A sinus lift entails elevating the sinus membrane and grafting bone into the sinus floor so that implants can be securely placed.
Ridge augmentation – when teeth have been missing for a long time or when periodontal disease has caused severe bone loss, adding to the height and width of bone in a large area may be indicated
Extraction site preservation - when extracting a tooth, it is ideal to place a site graft to maintain the bone for as long as possible
Nerve repositioning - If the inferior alveolar nerve requires movement to allow for the placement of implants, a bone grafting procedure may be required. The inferior alveolar nerve allows feeling and sensation in the lower chin and lip.
What does bone grafting treatment involve?
Bone grafting is a fairly simple procedure which may be performed under local anesthetic; however if large amounts of bone area need to be grafted, general anesthetic may be required.
Initially, the grafting material needs to either be harvested or prepared for insertion. Placement of the graft requires access to the area being grafted, which usually requires surgical access. The bone grafting material is then placed at the affected site.
The bone regeneration process may be aided by:
Gum/bone tissue regeneration – A membrane is placed over the grafting material. This barrier protects the graft duruing healing, limits the invasion of soft tissue, and can allow for formation of the prpoer type of soft tissue over the graft site.
Platelet-rich growth factors –A high platelet concentration liquid can be used to create a blood clot at the site of a wound. It has recently been discovered that PRGF also stimulates bone growth – meaning a denser graft in a shorter time period.
The gum is sutured in place and follow up appointments will need necessary to evaluate progress. Bone grafting is a highly successful treatment option, and the resulting sites are better prepared for the restorative dentistry that is planned.
If you have any questions about bone grafting, please ask your dentist.