Bone Grafting in Caldwell and Florham Park, NJ
Major & Minor Bone Grafting
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. In these situations, most patients are not candidates for placement of dental implants.
Bone grafts can repair defects of the jaws. These defects may arise as a result of tooth loss, an infection, traumatic injuries, cyst/tumor surgery, or congenital defects.
Today, we have the ability to predictably 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 aesthetic appearance. Basically, a bone graft acts as a framework which will guide your body to forming your own bone where it is needed. Most bone grafts are replaced with your own bone during the healing period. This process occurs on a cellular level and patients are unaware of the transformation.
Bone graft procedures may be performed separately or together when dental implants are being placed. This depends upon the individual’s condition. In many cases, Dr. Kirsch, Dr. Jacobs and Dr. Zambetti can use bovine grafts or allograft material to implement bone grafting for dental implants. Bovine bone has been used for many years and is a safe and reliable source for jaw bone replacement. Allograft is bone prepared from cadavers and used to promote the patients own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. It is now possible to use a patients own blood to accelerate and promote bone formation in graft areas as well as recombinant bone morphogenic proteins (rBMP).
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To reconstruct large defects, there are several areas of the body that are suitable for attaining bone grafts. 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. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. When we use the patient’s own bone for repairs, there are two surgical sites. One is the donor area and the other is where the graft will be placed. The advantages of using your own bone vs. a tissue bank or bovine source will be discussed in detail during your consultation visit. 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.
The great majority of these surgeries are performed in the office. While small grafts can be done comfortably under local anesthesia, larger and more extensive procedures typically involve some in-office form of sedation or general anesthesia.
Sinus Lift Procedure
The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. 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 to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone. There is a solution and it’s called a sinus graft or sinus lift graft. Drs. Kirsch, Jacobs and Zambetti enters the sinus from where the upper teeth used to be. The sinus membrane is then gently lifted upward and a bone graft 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 hold the implant, sinus augmentations and implant placement can often be performed as a single procedure. If not enough bone is available, the sinus augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
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 matured for a few months before placing the implant.
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 in the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or second premolar, with the above-mentioned secondary condition. There is almost always some postoperative numbness of the lower lip and jaw area, which dissipates very slowly and may be permanent. Due to the high risk of permanent nerve injury our surgeons do not favor this approach and will usually recommend less aggressive options.