major and minor bone grafting
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Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. Even if there has been bone loss, most patients are candidates for placement of dental implants. These straightforward, common procedures are usually done prior to implant placement, depending on individual patient needs.
Today, we have the ability to add and 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 functionality and esthetic appearance. |
major bone grafting
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Bone grafting can restore planned implant sites which have inadequate bone structure due to prior extractions, gum disease or injuries. The bone is either obtained from a tissue bank, just as orthopedic surgeons and neurosurgeons do for their patients, or your own bone could be taken from the jaw, hip or tibia (below the knee.) Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
Major bone grafts are typically performed to repair defects of the jaws These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The hip (iliac crest) and the area below the knee (tibia) are common donor sites. These procedures are routinely performed in an operating room and might require a hospital stay.
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sinus lift procedure
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The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty spaces. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone in order to be held in place. When the sinus wall is very thin, the area can be restored to a more healthful condition, receptive to implant placement, by performing bone grafting to the area.
The dental implant surgeon enters the sinus from where the upper teeth used to be. The lining of the sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone. The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures. If enough bone between the upper jaw ridge and the bottom of the sinus is available to adequately stabilize the implant, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation will be performed first. Once the graft has matured, the implants can be placed.
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ridge expansion
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In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and allowed to mature for a few months prior to implant placement.
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pre-prosthetic surgery
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The preparation of your mouth before the placement of a prosthesis is referred to as pre-prosthetic surgery.
Some patients require minor oral surgical procedures before receiving a partial or complete denture, in order to ensure the maximum level of comfort. A denture sits on the bone ridge, so it is very important that the bone is the proper shape and size. If a tooth needs to be extracted, the underlying bone might be left sharp and uneven. For the best fit of a denture, the bone might need to be smoothed or reshaped. Occasionally, excess bone would need to be removed prior to denture insertion. One or more of the following procedures might need to be performed in order to prepare your mouth for a denture:
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ridge preservation
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Bone grafting in the orofacial region is not a new procedure; it has been used extensively by oral and maxillofacial surgeons for many years, on many thousands of patients and for many different conditions. One of the best applications of bone grafting is to prevent collapse of the tooth supporting structures by replacing the missing bone at the time of extraction, before it’s too late. This is generally referred to as ridge preservation.
When a tooth is removed from its socket, the bone holding it in place may be too thin and fragile to retain its shape, resulting in collapse or fracture of the bone. This lack of bone strength is commonly due to pre-existing bone disease, frequently occuring as a result of gum and root canal problems. It can lead to both functional and esthetic deficiencies. If a bridge is planned in the area, and if the jaw bone (ridge) is not of the right shape, then the overlying replacement teeth will look or function incorrectly, and possibly both. Food trapping could become a very serious problem and esthetics are often compromised if there are gaps between the teeth and gums. To help prevent this problem, bone grafting material should be placed into the socket at the time of extraction by a dental surgeon trained in bone grafting procedures. In most cases, this can usually be done in one stage at the time of extraction, making the procedure much simpler and easier for the patient. Be sure to discuss the option of ridge preservation with Dr. Minkin |