- What is bone grafting?
It is a substitutional process for the missing part of the jaw bones, because there is no enough remaining bone to place dental implants with proper width and length. Dental implants with improper dimensions may be subjected to instability or mobility. Moreover, replacing the missing areas of jaw bones affects the patient’s facial impression and avoid the presence of ………….
What are the reasons for jaw bone loss?
There are many factors that may cause bone loss, but the most important one is tooth extraction, as the bone continues to resorb rapidly after extractions.
After one year of tooth extraction, bone loss begins to slow down regularly until it becomes very slow but continuous. For this reason, it is not advised to delay dental implant placement due to the preservation and in some instances, the growth of bone by means of titanium implants. As the process of implant insertion is delayed, the probability of bone grafting procedure increases.
Diabetic and osteoporotic patients are also prone to bone loss.
Moreover, smoking is a major factor of bone loss. Heavy smokers may suffer from losing most of the bone volume even without dental extractions.
What are the different available options to restore jaw bone loss?
Bone grafting procedures differs according to the volume and density of the remaining bone. In simple cases of bone loss, there may be enough bone to place the implant directly, but the density and volume of bone are not enough to support the implant and more bone loss are expected. In this cases we can place powder bone substitutes during implant insertion to make a stronger matrix of bone around the implant for more protection. The bone is either natural, artificial or both, and it is covered by a collagen membrane or some other biogenic membranes for better protection.
As the amount of bone loss increases, more details are included in the bone grafting procedure. In many cases we are not able to place the implant directly due to massive bone loss. In these cases, we need to fix a bone block by screws to the original bone and left for six to nine months to heal and fuse with the original bone. After this period, the implants can be placed and bone particles may be still needed in this stage. These bone blocks may be extracted from the patient’s chin or ribs, or may be synthetic.
Long time after extraction the maxillary sinus begins to drop downwards towards the crest of the bone in what we call, sinus pneumatization, this procedure is normal, but it leads to vertical bone loss which may prevents placing implants with proper lengths. In these cases, a sinus lifting procedure is indicated to place more bone in the area and gain more vertical dimension of bone. This procedure may be carried out directly during implant insertion, in this case no additional surgeries are needed. When the remaining bone is very little, an additional sinus lifting surgery is needed to place enough bone in the area to be implanted. Implants are then placed 6 months after the surgery.