Bone Grafting
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Over a period of time, the jawbone associated with missing teeth atrophies or shrinks. This often leaves an inadequate quantity of bone for implant placement. Nearby structures such as the sinuses or nerves may also interfere with implant placement. When this situation occurs reconstructing the jaw with bone grafts is often the solution. This gives us the opportunity to place implants of the desired dimension in the best location to restore function and esthetics.
Socket preservation
This method of grafting is selected when significant bone loss is expected after tooth extraction. It is intended to preserve the size and shape of the jaw in the area of the tooth extraction thereby enabling future implant placement. This is considered a minor degree of grafting and is performed immediately after the tooth is removed. The procedure involves placing bone grafting material into the extraction socket to fill the socket completely. The socket opening is then sealed with a dissolvable membrane or is closed off with adjacent gum tissue. Four to six months of healing is allowed before an implant is inserted into the area of the graft.
Sinus grafting
In some people the maxillary sinuses are large and can interfere with implant placement in the upper back jaw region. This condition can be detected with radiographs of the area. When this condition exists sinus grafting can provide the correct quantity of bone for implant placement.
The sinus graft is a common procedure and is usually accomplished in the office under intravenous sedation or local anesthesia. It involves elevating the existing sinus floor and placing bone graft material into the area. In some cases, implants may be inserted at the time of sinus grafting thereby allowing simultaneous graft and implant healing. In situations where there is less bone the implant placement may be delayed to allow for graft healing. Once in place the graft, with or without implants, will be allowed to heal for four to six months.
Onlay grafting
Smaller bone defects can be corrected with the application of blocks of bone harvested from the back part of the lower jaw or from the chin region. This is an effective way to restore proper jaw form prior to implant placement. It is usually performed in the office with local anesthetic alone or in combination with intravenous sedation. The usual healing time for this type of graft is approximately four months. Harvesting bone from the jaw for grafting does not weaken the jaw or change the facial appearance; in fact, the bone usually regenerates at the harvest site after about six months.
Major grafting
The amount of bone loss will dictate how extensive the grafting will be. People who have suffered extensive loss of bone from trauma, birth defects, or long-term denture use are more likely to require major bone grafting. Major grafting involving the reconstruction of an entire dental arch may require harvesting bone from the hip and transferring this bone to the jaw where it is secured in place and allowed to heal. This technique requires hospitalization and use of an operating room. An overnight stay is usually required. The graft is allowed to heal for approximately four months before implants can be inserted into the grafted bone. In most cases it is usually possible to continue to use some form of dental prosthesis while the bone grafts and implants are healing, thus enabling continued esthetics and function throughout treatment.
Recovery
The recovery time after grafting will depend on the type of graft performed. Socket preservation may have little or no recovery while major grafting may require one to two weeks. There will be some individual variation which can be explained by your surgeon. Any dental prosthesis to be worn is carefully adjusted to minimize any irritation to the site of the graft. Patients are usually asked to follow a soft diet. Healing times will vary depending on the type of graft used and can range from three to nine months.
