Replacing Bone for Dental Implants
Even if they do not know exactly what they are, most people have likely heard about dental implants. On the other hand, bone grafting is probably less commonly known. This is ironic considering bone grafts and dental implants often go together in dentistry.
It is fairly normal for patients that are considering dental implants to be told they need a bone grafting procedure prior to their implant surgery. While bone grafting may sound scary or intimidating, it is not a procedure that should be feared. It is a routine dental procedure that is both predictable and painless.
Dental Implant Overview
Dental implants are a great solution for restoring lost or missing teeth. Because they are surgically imbedded directly into the jawbone, the metal dental implants act as replacement tooth roots upon which a restorative crown can be mounted. Once placed, a natural healing process called osseointegration occurs where the implant and jawbone fuse together. Proper osseointegration is vital to the long-term success of the implant and since the implants are placed directly into the jaw, sufficient bone is required to support the device and allow complete fusion. If there is not enough bone to work with, it is impossible to place the implant.
When is Bone Grafting Required?
Bone grafts are required when the patient lacks sufficient natural bone in their mouth necessary to support dental implants. Bone density could be deficient because of:
* Developmental defects
* Periodontal (gum) disease
* Trauma or injury to the face
* Empty spaces left after teeth were removed or lost
Patients that lose a tooth may require a bone graft prior to placing a dental implant regardless of how recently the tooth was lost. Even if the patient comes in for a dental implant the day after losing a tooth, the socket could become infected, or the missing tooth could be a size that would not support an immediate restoration.
In practice, most patients do not visit the dentist for an implant the day the tooth is lost. In some cases this is due to financial concerns. In other cases, the reason is logistical. Regardless of the reason, bone loss continues every day the tooth is absent.
Typically, it is the alveolar bone that is affected when teeth are lost. The responsibility of the alveolar bone is to support and hold the teeth. Without a tooth, the alveolar bone begins to atrophy due to lack of work. Additionally, the jawbone builds up and strengthens every time the patient chews. As such, alveolar bone loss can also expedite jawbone loss.
The only way to know if a bone graft is needed is to schedule an initial consultation with a dentist. The dentist will determine if a graft is necessary and what type of bone graft to use.
How Does a Bone Graft Work?
There are multiple types of bone grafts and various materials available and which is used depends on the extent of the patient’s damage and the location of the missing tooth. Bone grafts can be classified based on the source of material used:
* Autograft: Uses tissue transferred from one location on the patient’s body to another; typically requires multiple surgeries.
* Allograft: Uses tissue sourced from a human donor.
* Xenograft: Graft is sourced from another species of donor (i.e. cow, horse, or pig)
* Alloplast: Grafts are inorganic, synthetic materials.
A socket graft is the most common bone graft type, and its primary purpose is to prevent the alveolar bone from atrophying. Human donor bone is usually placed into the socket to prevent its collapse. Typically, four to six months will be needed following a socket graft before the patient will be ready for implants. A bonus of socket grafts is that post-operative pain from implant surgery is minimized.
Lateral ridge preservation grafts are another bone graft type and generally, human donor bone is also used. The goal of these grafts is to widen the jawbone so that a dental implant can be accommodated. The block bone graft is another graft option that is generally used to correct large jawbone defects. To perform the block bone graft, a small block of bone is taken from the back of the patient’s jaw, placed into the defective area, and held in place with small titanium screws. Both the block bone and lateral ridge preservation grafts require between four to six months to heal.
The final bone graft type is called a sinus lift procedure. Xenografts (often equine) are generally used so that the graft may be expanded. In some cases, the xenograft could be added to human donor bone. Sinus lifts are needed when the patient requires implants in the upper jaw which typically are not stable enough to support implants on their own. Equine bone is commonly used because it provides two unique advantages. It does not dissolve as fast as human bone and microscopically, is more similar to human bone than other options. Equine bone creates a “scaffold” that supports the growth of additional bone in the sinus. Because of the complex anatomy of the sinus cavity, 8-12 months are typically required to heal from a sinus lift.
Is a Bone Graft Painful?
Bone grafting procedures are straightforward, performed on an outpatient basis, and because the patient is sedated throughout the procedure, the process is painless. There should not be pain while the graft heals and once done, the patient will be ready for their dental implants.
After the grafting procedure is completed, the oral surgeon will likely prescribe antibiotics to prevent infection. In some cases, pain killers may be prescribed but most patients that receive bone grafts are pain-free and do fine if they take the course of antibiotics.
Before the dentist can place dental implants, it is necessary for the bone graft and natural bones to fuse together. Everyone’s mouth is different and as such, the exact timeframe for recovery varies. In general, it is common for 3 to 12 months to be needed for proper fusion between the graft and natural bones. During the recovery period, regular checkups with the dentist will be needed to determine when the patient is ready for their dental implants.