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.
Initially, Dr. Gray will thoroughly examine the affected area in order 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 often need to be fully addressed before the bone grafting procedure can begin. Dr. Gray will also recommend radiographer imaging in order to assess the precise depth and width of the existing bone. This may involve obtaining a CT scan (cone beam computed tomography) to further evaluate your potential surgical site. Based on your exam findings and radiograph if findings a personalized plan is created to achieve the desired result.
What Does Bone Grafting Involve?
There are several types of bone grafts. Dr. Gray will determine the best type for your particular condition.
Autogenous Bone Graft - Harvested from the patient’s own body (usually from the posterior part of the lower jaw or the chin). This method is used because it produces the most predictable results. It however requires a second surgical site and some discomfort from that surgery.
Large Autografts: Occasionally a patient presents to my office with a very large bony defect that requires a large bone graft to remedy his/her defect. These cases may require bone from the sites mentioned above or additionally from the hip bones, tibia or other sources. These harvest techniques are typically performed in the Operating room in a hospital based environment. Feel free to ask Dr. Gray if these grafts may be indicated in your case.
Allograft Bone Graft - This is highly processed cadaveric (human) bone. It works well to restore most missing bone and obviously does not require obtaining it from your body. The graft is ultimately converted into your own bone in 6-12months. Risk of transmission of disease is very remote and is less than 1:1,000,000. Dr Gray uses only reputable sources for his allografts.
A little about these grafts and how they make it to my office ........Human Donors with risk factors for transmissible disease are not allowed to participate in transplant program. Those that are accepted are screened with FDA cleared methods and tests for transmissible disease to further remove any positive patients. Once a donor is certified by a medical director to have negative results for transmit able diseases. Next the grafts are harvested in clean rooms very similar to hospital operating rooms. These grafts are then linked to the original donor with traceable serial numbers for tracking purposes. The grafts are then bathed in strong detergents and solvents(alcohols and acetone) for prolonged periods removing viable cell and soft tissues. Finally the grafts are bathed in antibiotic solutions and packaged to be irradiated and sterilized with gamma radiation. Please ask Dr. Gray if you have any questions.
Xenograft - This is a bone graft taken from an animal source. Usually this is a cow or pig that is harvested and the tissue is processed in a similar fashion as is an allograft. These grafts take longer to be converted into you own native bone. Some studies show this can take 24 months.
WHAT TO EXPECT WITH A GRAFT PROCEDURE
The bone grafting procedure can often take several months to complete. Bone is either harvested or obtained from a tissue/bone bank and added to the affected site. This bone will fuse with the existing bone and the migration of your cells into the graft will cause firm adhesion of the growth and ultimately vital or alive bone. Supplementing the jaw with bone will result in greater bone mass to help support and anchor the implant(s).
During the surgery, the Dr. Gray will numb the grafting and extraction sites using local anesthetic often with Intravenous Sedation. An incision will be made to prepare the site for the new bone and it will be anchored into place. On occasion, a synthetic or resorbable membrane may be used to cover the new bone. This membrane prevents soft tissue and bacterial invasions, and encourages new bone growth. Typically the graft placement portion of the surgery is not especially painful but the harvest procedure can be. It is recommended that you consider clearing your schedule and responsibilities for the 2-3 days after the surgery. Most patients require narcotic pain medications for the first 2 days after surgery and thereafter can get by with over-the-counter pain medications.The surgery is performed in office. As always, you will be provided with comprehensive instructions for your post-operative care.