Implants: Implant-Related Bone Grafting

Implant-Related Bone Grafting

Unfortunately, when teeth are pulled, the remaining jawbone begins to change, with the bony ridge losing height and width over time. Studies have shown that the most rapid and extensive changes occur in the first six months after tooth extraction. If these changes are not taken into consideration, the implant may end up in the wrong position, relative to the opposing teeth. If this happens, the resulting restoration may become compromised. The restoration may require contours that are difficult to keep plaque-free and healthy. Normal chewing forces may result in abnormal forces being applied to the implant, which can lead to mechanical failures such screw loosening, screw breakage, bone loss around the implant and even implant fractures.

In order to prevent these types of problems from happening, implants must be placed in the correct positions. If the bone is deficient in these positions, various bone grafting/regeneration techniques are employed to regenerate what is needed.

Left to right top: Bone is deficient for implant placement next to canines. - After grafting, the ridge is wide enough. Left to right bottom: Implan supported, bridge in place. - Nice smile!

Left to right top: Bone is deficient for implant placement next to canines. - After grafting, the ridge is wide enough. Left to right bottom: Implan supported, bridge in place. - Nice smile!

Guided Bone Regeneration

Bone grafting is commonly done in implant dentistry. Typically, the implant is placed using a positioning guide, and a portion of the implant has deficient bone height or thickness around it. Bone particles are placed into the deficient areas and covered with a dissolving or non-dissolving barrier membrane. This separates the graft from the overlying gum tissues, allowing the graft to integrate with your bone, while at the same time, the implant is attaching to your jawbone.

Left to right: Severely resorbed ridge. - After grafting, the ridge is wide enough. - Implant supported, bridge in place.

Left to right: Severely resorbed ridge. - After grafting, the ridge is wide enough. - Implant supported, bridge in place.

Occasionally, the amount of jawbone present is insufficient to place an implant. In these cases, bone grafting is done ahead of time and several months later, the implants are placed into the grafted bone. This type of grafting can get quite complex, time consuming and expensive. This is why we recommend placing implants as soon as possible after a tooth is lost.

Left to right top: Missing upper left molar. - Implant 5 years after successfull restorarion. Left to right bottom: The white line is the floor of the sinus. - Bone graft in place after an osteotome sinus left. - Implant successfully placed.

Left to right top: Missing upper left molar. - Implant 5 years after successfull restorarion. Left to right bottom: The white line is the floor of the sinus. - Bone graft in place after an osteotome sinus left. - Implant successfully placed.

Sinus Lift

As we get older, our sinuses tend to expand and grow larger at the expense of our upper jawbone. This is of little consequence…until back teeth are lost. When upper back teeth are lost, and implants are desired, there often is too little jawbone ridge height remaining below the sinus floor to hold an implant. Fortunately, we can overcome this through a procedure called a sinus lift.

Left to right top: Missing upper right molars and bicuspid. - First molar and second bicuspid succssfully restored. Left to right bottom: Surgical guide showing bone height is deficient for implant placement. - Bone graft in place, lateral approach. - Implants successfully placed.

Left to right top: Missing upper right molars and bicuspid. - First molar and second bicuspid succssfully restored. Left to right bottom: Surgical guide showing bone height is deficient for implant placement. - Bone graft in place, lateral approach. - Implants successfully placed.

The sinus is basically an air cavity that is lined by a membrane that fortunately, can be carefully lifted from the bone and bone graft material can be placed into the created space. The graft is eventually replaced by the patient’s bone and is suitable for attaching to and holding a dental implant. Amazingly, with careful technique and proper care after the procedure, recovery is usually comfortable and uneventful. Sinus lifts are a common procedure in implant dentistry today and research shows that implants placed into the grafted bone have very high success rates.