| Bone Grafting
Over a period of time, the jaw bone associated with missing teeth atrophies or shrinks. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
We now have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functional and esthetic appearance. The bone graft procedures are referred to as:
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Sinus Lift Procedure
This procedure involves elevating the sinus membrane and placing the bone graft onto the sinus floor, allowing implants to be placed in the back part of the upper jaw
Ridge Augmentation
In severe cases the ridge has been reabsorbed and a bone graft is placed to increase the ridge height and/or width.
Nerve Repositioning
The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants to the lower jaw.
These procedures may be performed separately or together, depending upon the individual's condition. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. Various types of synthetic grafting materials may also be used.
These surgeries are performed in our office O.R. under I.V. sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.
Platelet Rich Plasma
With many of the bone graft procedures we perform, we use platelet rich plasma (PRP) to aid in the healing of the graft. PRP is made from a small sample of the patient’s own blood drawn at the time of surgery. The blood is placed in a specialized centrifuge that spins and separates the red blood cells from the plasma. The plasma is decanted off and the plasma is further centrifuged to create a high concentrated number of platelets in a small amount of plasma. This mixture of Platelet Rich Plasma is applied to the area of the graft to enhance the healing. Platelets are small cells found in the blood that are partially responsible for causing the blood to clot. Platelets also contain large reservoirs of growth factors, which are necessary to begin tissue repair and regeneration at the wound site. These growth factors initiate connective tissue healing, bone regeneration and repair, and development of new blood vessels. PRP is the only available product that contains elevated levels of naturally occurring growth factors. Since PRP is made from the patient’s own blood, there is virtually no risk of disease transmission.
Distraction Osteogenesis
In 1991 Gavriel Illizarov, a Russian orthopedic surgeon, published a paper outlining an unbelievable procedure in which he reconstructed severely foreshortened and deformed extremities by making osteotomy cuts through the existing bone and, over time, lengthening the limb. The technique was named distraction osteogenesis, growing bone by distracting the segments over time. This not only restored the length of bone but also all the surrounding soft tissue to function with minimal surgical intervention.
This technique has been adapted in the maxillofacial area and has been implemented with success in the correction of certain skeletofacial deformities. Most recently this technique has been adapted to restore alveolar ridge defects caused by traumatic tooth loss, periodontal tooth loss, and the natural resorption following tooth extraction. These alveolar defects can create problems with restoring edentulous areas to proper form and optimal function. In the past we have relied on various bone grafting techniques which can improve the alveolar ridge form but also present limitations and various complications. Distraction osteogenesis is less invasive and can, in many cases, restore both hard and soft tissue alveolar defects to optimal form faster than with bone grafting techniques. This technique can be especially helpful in preparing insufficient alveolar ridges for implants and in some cases can improve the esthetics for fixed bridges.
To learn more about distraction osteogenesis, go to distraction.net.
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