Bone Augmentation (Bone Grafting)
Bone Augmentation often referred to as “bone grafting”, is a procedure to replace atrophied or missing bone in the jaw. Bone atrophy or bone loss can be caused because a tooth or multiple teeth are missing and the bone will dissolve over time. The body will naturally re-contour the bone in the jaw if there is not a tooth root or implant to maintain the bone level. Bone grafting is usually used in conjunction with implant placement. Implants have the best the best chance of success when surrounded by thick healthy bone. There is a variety of way to replace lost bone. Below you can read about different examples of bone replacement therapies.
Particulate Bone Grafting
A particulate graft consists of small bone particles place strategically around a tooth site. Particulate grafting is usually for a small single tooth area in preparation for a single implant placement. Particulate grafting can be done before or during implant placement. It is often completed when an extraction is done and an implant is placed at the same time. The particulate bone is placed in the voided area around the implant for optimal healing of an implant. The time of placement is discussed between the patient and the doctor and is determined based on the patient’s individual needs. Particulate graft materials come in a variety of synthetic and human bone substitutes. Patients may discuss the different bone augmentation sources and choose the most desired treatment based on their body and beliefs. Bone augmentation may also be grafted directly from the individual patient and milled to the correct particle size and placed where the bone grafting is needed, keeping the graft completely autogenous to the patient.
Block Bone Grafting
A block graft can be harvested from the patient or it can be a human or bone substitute. The block is ordered or harvested at the size of the needed replacement. The block is tacked into place with a fixation screw or tack and left to heal for a period of some months until the patient’s body accepts the graft and in becomes natural bone to the patient’s body. After the healing phase is complete the area is ready for implant placement.
Sinus Augmentation (Sinus Lift)
A sinus augmentation is when the bone ridge is too shallow to place an implant and needs to be heightened to place an implant. In a sinus augmentation, a thin layer of the membrane is carefully lifted and bone is packed into the cavity between the bone ridge of the jaw and the sinus floor. Sinus lifts are a common procedure in conjunction with an implant. Sinus lifts are only on the upper jaw. Sinus Augmentations can be performed various ways.
Lateral Sinus Lift
A Lateral approach sinus lift consists of opening the tissue and bone on the cheek side of the upper jaw. A small window in the bony plate is carefully thinned out and removed until the sinus membrane is exposed. The sinus membrane is a thin mucous tissue, somewhat like a balloon. The membrane expands and contracts as your breath in and out through your nose; much like a balloon. The membrane is carefully peeled away from the bone, remaining intact. Special instruments hold the membrane away from the opening while a bone material is packed into the open cavity between the sinus membrane and the sinus floor. The membrane will naturally lay on the new bone graft and heal back into place. During the healing phase, the bone graft will become solid bone. Once the healing has taken place the augmented area is ready for an implant.
Crestal Sinus Lift
A crestal sinus lift is another option for a sinus augmentation. A crestal approach is accessed from the “crest” of the bony ridge where the teeth and gum line meet. A crestal approach to the sinus can be accessed through the root socket of an extracted tooth or it can be drilled with a series of special instruments. An opening is made until the sinus is exposed but the sinus membrane remains intact. A special tool seals off the hole exposing the sinus and saline, a sterile salt water mixture is pumped into the socket and it slowly elevates the sinus membrane. Once the membrane is lifted a bone material is inserted between the sinus membrane and the sinus floor, thus lifting the sinus. The sinus floor will naturally lay back down on the new graft and heal into place. Once completely healed, bone graft material will become solid bone. An implant can be placed at the same time as the crestal sinus approach, but the doctor will evaluate each patient on a case by case basis to determine that.