Atrophy or bone deficiency is a very common problem in modern dentistry. In this case, bone grafting will be the only way out.
Indications for bone grafting
Dentists perform bone grafting in the following clinical cases.
- Jaw injury.
- Traumatic tooth extraction.
- Prosthetics of several teeth at once.
- Bone inflammation leading to a decrease in bone tissue.
- The need for implantation.
Bone grafting during implantation is the most common concomitant implantation procedure, and most often grafting is performed for this reason.
Bone grafting during implantation
When a doctor tells the patient that he needs bone grafting when implanting teeth, “what is it and why is it needed” is a logical question that everyone can ask. If after you have lost your tooth, a lot of time has passed, then the bone tissue must decrease.
Its dystrophy occurs because the tissue no longer experiences the load from the tooth, which means that the body believes that it is not necessary, and the tissues begin to absorb both in width and in height.
And when installing the implant, it is necessary that the tissues surround and hold it tightly. By standards, the classic implant requires approximately 10 millimeters of bone tissue in height and 3 millimeters on each side. If the tissue is insufficient, then building should be done.
Types of bone grafts
To perform bone grafting, the patient needs to install a bone graft, which will take root over time and replace the missing tissue. Transplants are of the following main types:
- Autogenic transplants. The bone for them is taken from the patient himself. As a rule, the bone block is removed from the lower jaw, from the area beyond the extreme molars. If bone cannot be taken from there, then the bone tissue of the thigh is taken. Such a block takes root best, but an additional operation has to be carried out.
- Allogeneic transplants. They are obtained from human donors, and then carefully selected and sterilized. As a result, the individual properties of the bone are lost, and it can easily be used as a block.
- Xenogenic transplants. Here, the source of the material is cattle. The block is processed to become completely sterile and compatible with the human body.
- Alloplastic transplants. Completely artificial blocks that mimic the structure of the bone. After the operation, they gradually dissolve or become a support for the growth of a person’s natural bone.
There are several different methods of bone grafting, because modern dentistry is constantly being improved. As a result, in different clinical cases, more suitable methods can be used. There are really a lot of techniques, but only some are worth considering in detail.
Directed Bone Regeneration
Recently, targeted bone regeneration has been quite popular - replanting special membranes compatible with the human body that accelerate the formation of jaw bones. The membranes are made of special collagen fibers that are not rejected by the body and are sometimes saturated with a compound that stimulates bone growth.
Membranes are absorbable and non-absorbable, depending on how long it takes to hold the frame.
After the membrane is implanted in the right place, the wound is sutured, and you have to wait for a while until the bone tissue grows. Usually this process takes about six months.
Directed regeneration is also bone grafting during dental implants. Photos of the blocks used for regeneration, you can see below.
Sinus lift
Sinus lifting is a specific bone grafting that increases the volume of bone grafting on the upper jaw by raising the maxillary sinus.
Sinus lifting is prescribed in the following clinical cases:
- If the patient has no pathologies in the area of operation.
- With a complete lack of risk for the development of complications.
In this case, sinus lift in a number of clinical cases is contraindicated:
- Constant runny nose.
- The presence in the maxillary sinus of multiple partitions.
- Polyps in the nose.
- Sinusitis.
- Problems and diseases affecting bone tissue.
- Nicotine addiction.
Some of the contraindications can be eliminated, and only then directly sinus lift.
Sinus lifting is carried out in two main ways:
- Open operation.
- Closed operation.
Open sinus lift is a complex procedure that is performed if there is a lack of a sufficiently large volume of bone tissue. It is carried out in several stages:
- The dentist slightly incisions the mucous membrane outside the sinus.
- The mucous tissue of the sinus is slightly elevated.
- The void is filled with the material that will be used for building.
- The exfoliated mucosa is put in place and everything is sutured.
If the bone tissue does not get a little, no more than 2 millimeters, then you can conduct a closed sinus lift. It is done like this:
- First of all, an incision is made in the jaw at the site of the planned implant placement.
- Then, with a special dental instrument, the doctor lifts the maxillary sinus fundus through this incision.
- Deep in the hole is osteoplastic material.
- Immediately after this, an implant is placed in the jaw.
Bone block grafting technique
Bone block grafting is done less frequently than regeneration or sinus lifting, since it implies the use of transplants and their long engraftment. Such a unit is mounted in different ways, sometimes even with special titanium screws. After six months, the unit is fully assimilated, the titanium pins are pulled out and implantation can be performed.
Bone block grafting is performed as follows:
- The gum is cut.
- A special tool splits and spreads bone tissue.
- Osteoplastic material is placed in the resulting cavity.
- The graft is fixed with titanium feints in natural bone tissue.
- All gaps are filled with a special crumb, stimulating the formation of bone tissue.
- A special membrane is applied to the graft.
Bone block grafting is usually done if you need to increase not only the height, but also the width of the bone tissue in the jaw, or if there is a lot of bone tissue.
Bone grafting during dental implants: complications
As with any operation, with bone grafting before implantation, some complications may well arise. The reviews say that they are possible:
- Bleeding. In the first two hours after the procedure, a little bleeding is quite natural, but if it continues all day, you should go to the doctor.
- Pain and swelling. In the first 2-3 days they are completely natural, they are removed with antibiotics and painkillers. If the pain only gets worse, it is best to visit a doctor as well.
- Numbness of the jaw. If it lasts several hours, then this may be a sign of nerve damage.
- Edema. If it makes breathing difficult and prevents you from opening your mouth, then urgent medical attention is needed.
Bone grafting during dental implants: reviews
In general, patients about bone grafting respond positively. Most often, targeted bone regeneration and sinus lift are done. The only drawback, as many note, is the increased cost of the already expensive implantation, as well as the long bone engraftment period. The second drawback is deprived only of a closed sinus lift. In any case, bone grafting is something that should be avoided, and the only way out is to place the implant immediately after the loss of a tooth.