Advanced Bone Grafting
Advanced Bone Grafting
The unknown can be scary – especially when it involves you or a loved one undergoing surgery of any kind. At Texas Oral Surgery Group, we understand that our patients don’t live and breathe dental surgery – that’s our job! We also know that surgical terms and medical jargon can be confusing, so we’ve provided an outline of some bone graft procedures to help eliminate some of the unknown.
What is bone grafting?
Bone grafting is a surgical procedure that replaces your missing jaw bone with material from either a patient′s own body or a substitute. The human body is an incredible thing, and bone tissue can regenerate if it’s provided the space in which to grow. And, as natural bone grows, it generally replaces the graft material resulting in a fully integrated area of new bone. The development of advanced bone grafting techniques has allowed us to be able to treat patients that were previously unable to receive optimal care.
When is bone grafting used?
Defects of the jaw caused by traumatic injuries, congenital defects or tumor surgery are generally treated with major bone grafts using the patient’s own bone – often taken from the skull, hip, or lateral knee. These types of bone graft procedures are performed in an operating room and require a hospital stay. However, in the oral surgery office, bone grafting is more commonly used to allow for the proper placement of dental implants. In fact, anyone who has lost a tooth might need a bone graft before it’s possible to place a dental implant. Your body experiences bone loss every day a tooth is missing which, over time, leads to disuse atrophy in the jawbone. Disuse atrophy occurs when bone that is supposed to support teeth is reabsorbed resulting in poor quality and/ or quantity of bone suitable for placement of dental implants, or fixed or removable appliances.
Bone Grafting Procedures
Just as the name implies, the primary purpose of socket preservation is to prevent the atrophy, or preserve the health, of the alveolar bone (i.e. the socket that holds the tooth in place). This bone is often damaged by disease and/or infection, which necessitates a tooth extraction that can create a jaw deformity if preventative measures aren’t taken. These grafts are some of the most common and easiest bone grafts to perform and recovery is usually uncomplicated. Beyond cosmetic concerns, jaw defects also create major problems in performing restorative dentistry, which is why it’s important to speak with your dentist, about socket preservation if they recommend tooth removal.
Typically performed in Drs. Stewart and Michael‘s office under IV anesthesia, ridge augmentation helps recreate the natural contour of the gums and jaw which may have changed due to bone loss from a tooth extraction or traumatic injury. Ridge augmentation is achieved by placing bone graft material in the tooth socket. This procedure is often done immediately after a tooth is removed to avoid the need for a follow-up procedure, however it can be done on patients with long standing tooth loss.
This procedure is recommended when a patient needs an implant in the upper jaw but has a thin sinus floor that is unable to hold implants on its own. One of the most common bone grafting procedures for patients with bone loss in the upper jaw, a sinus lift grows bone in the floor of the maxillary sinus, increasing bone height and volume, to enable the secure placement of dental implants.
Types of Bone Grafts
Autogenous Bone Grafts
Autogenous bone grafts, or autografts, are made from your own bone and typically harvested from the chin, jaw, lower leg, hip or skull. Autogenous bone grafts are advantageous because the graft material is live bone containing living cellular elements that enhance bone growth. It also eliminates the risk of rejection, as it comes from your body. It’s important to note that this type of bone graft does require a second procedure to harvest bone from elsewhere in the body which, depending on your medical health, may not be in your best interest.
Allogenic bone grafts, or allograft, use dead bone that is harvested from a cadaver and processed using a freeze-dry method to extract the water and cellular components, via a vacuum. Unlike autogenous bone, allogenic bone cannot produce new bone on its own. Instead, it serves as a framework that bone from the surrounding bony walls can grow upon to fill the defect or void. This type of graft depends upon the patient having a good bone support structure in order to be effective.
This type of graft uses non-living bone from another species, usually bovine. To avoid contamination and the potential for rejection, the bone is processed at very high temperatures. Similar to allogenic grafts, xenogenic grafts serve as a framework for bone from the surrounding area to grow and fill the void. Both allogenic and xenogenic bone grafting have the benefit of not requiring a second procedure to harvest bone. However, since these options lack autograft’s bone-forming properties, bone regeneration may take longer and they tend to have a less-predictable outcome.
If Drs. Stewart or Michael determine that the best course of action is to use a real-bone substitute, there are a number of safe and proven synthetic alternatives, including:
Demineralized Bone Matrix (DBM)/Demineralized Freeze-Dried Bone Allograft (DFDBA)
This product is processed allograft bone (i.e. bone harvested from a donor). It contains collagen, proteins, and growth factors that have been extracted from the allograft bone. It’s available as powder, putty, chips, or a gel that can be injected through a syringe.
Graft composites use other bone graft materials and growth factors to achieve the benefits of a variety of substances. Some combinations may include collagen/ceramic composite, which closely resembles the composition of natural bone; demineralized bone matrix combined with bone marrow cells, which aid in the growth of new bone; or a collagen/ceramic/autograft composite.
Bone Morphogenetic Proteins
Bone morphogenetic proteins (BMPs) are proteins naturally produced in the body that promote and regulate bone formation and healing. During surgery, BMP is soaked onto and binds with a collagen sponge. The sponge is then designed to resorb, or disappear, over time. As the sponge dissolves, the BMP stimulates the cells to produce new bone. The BMP also goes away once it has completed its task of jump starting the normal bone-healing process.
While synthetic materials have the advantage of not requiring a second procedure to harvest bone, each option has risks and benefits and Drs. Stewart and Michael will determine the type that best meets your particular needs.
Bone grafting, whether in preparation for restorative dentistry or for other reasons, is a technically sensitive procedure that requires a skilled professional. Texas Oral Surgery Group patients can feel confident knowing that in addition to Dr. Stewart’s extensive lecturing on the topic, he and Dr. Michael have a combined 50+ years of experience in the field.
We’re here to answer your questions. Please contact any of our four convenient office locations to schedule a consultation.
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