Bone Grafting

Bone grafting is often closely associated with dental restorations such as bridge work and dental implants. In the majority of cases, the success of a restoration procedure can hinge on the height, depth, and width of the jawbone at the implant site. When the jawbone has receded or sustained significant damage, the implant(s) cannot be supported on this unstable foundation and bone grafting is usually recommended for the ensuing restoration.

There are several major factors that affect jaw bone volume:

Periodontal Disease – Periodontal disease can affect and permanently damage the jaw bone that supports the teeth. Affected areas progressively worsen until the teeth become unstable.
Tooth Extraction – Studies have shown that patients who have experienced a tooth extraction subsequently lose 40-60% of the bone surrounding the extraction site during the following three years. Loss of bone results in what is called a “bone defect”.
Injuries and Infections – Dental injuries and other physical injuries resulting from a blow to the jaw can cause the bone to recede. Infections can also cause the jaw bone to recede in a similar way.

Reasons for bone grafts

Bone grafting is a highly successful procedure in most cases. It is also a preferable alternative to having missing teeth, diseased teeth, or tooth deformities. Bone grafting can increase the height or width of the jawbone and fill in voids and defects in the bone.

There are essentially two basic ways in which bone grafting can positively impact the health and stability of the teeth:

Jaw Stabilization – Bone grafting stabilizes and helps restore the jaw foundation for restorative or implant surgery. Deformities can also be corrected and the restructuring of the bone can provide added support.

Preservation – Bone grafting can be used to limit or prevent bone recession following a tooth extraction, periodontal disease, or other invasive processes.

Oral Examination

Initially, Dr. Garvey will examine the affected area to assess the general condition of the teeth and gums. If periodontal disease is present or the adjacent teeth are in poor condition, these factors will be fully addressed before the bone grafting procedure can begin. Panoramic x-rays and a CAT scan will be used to assess the precise depth and width of the existing bone.

What Does Bone Grafting Involve?

There are several types of bone grafts. Dr. Garvey will determine the best type for your particular condition.

Ridge-augmentation with Onlay Grafting

Onlay Grafting is typically reserved for cases where bone support is very deficient. A bone graft using your own bone is placed to increase the ridge width and/or height. In these situations, the graft is taken from another area inside your mouth and transplanted into the deficient area. Once transplanted, it will grow in its new location. This in-office procedure is usually performed using a sedative or general anesthesia.

Guided Tissue Regeneration (GTR)

GTR can be used in cases where the bone support is mildly to moderately deficient. Your own bone can be used; however GTR is most often done using particulate bone substitutes. Using bone substitutes gives the advantage of not needing an additional procedure to take your own bone. There are several types and sources of bone substitutes. Dr. Garvey will discuss the most appropriate one with you.

The deficient area is filled with bone or a bone substitute and covered with a protective membrane. Early on, the filler material will support the tissue surrounding the deficient area, and in time will be replaced by new bone.

Soft Tissue Grafting

When soft tissue support is deficient a Connective Tissue Graft may be performed. A small piece of tissue is taken from your palate and placed to cover the defect.

Sinus Lift

A sinus lift, sometimes called a sinus augmentation, is surgery that adds bone to your upper jaw (maxilla) in the area of your molars and premolars to make it taller. The bone is added between your jaw and the maxillary sinuses, which are on either side of your nose. To make room for the bone, the sinus membrane has to be moved upward, or "lifted." A sinus lift is done when there is not enough bone in the upper jaw, or the sinuses are too close to the jaw, for dental implants to be placed.

The bone grafting process can often take several months to complete. The new bone will fuse with the existing bone and the migration of cells will cause firm adhesion and cell growth. Supplementing the jaw with bone will result in greater bone mass to help support and anchor implants.

During the surgery, Dr. Garvey will numb the grafting and extraction sites using local anesthetic. A small incision will be made to prepare the site for the new bone and it will be anchored into place. On occasion, a synthetic membrane may be used to cover the new bone. This membrane prevents soft tissue and bacterial invasions and encourages new bone growth. The surgery may be done with sedation and does not require an overnight stay. You will be provided with comprehensive instructions for your post-operative care and medications to help manage infection, discomfort and swelling will be prescribed.

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