Bone Grafting Procedures in Implant Dentistry

Technology advances in dental implants has made it possible to rectify and reconstruct various dental issues. One can replace and re-grow new teeth in place of broken or missing teeth. In the past couple of years, bone grafting has developed into a major implant dentistry procedure. The outcome of this procedure has redefined dentistry and dentists are now able to achieve results which were not possible before.

Understanding Bone Grafting

Bone grafting is essentially a surgical procedure wherein missing bones are replaced in order to repair bone fractures which are complex and also pose a health risk to the patient. Usually bones are able to regenerate but require a scaffold to aid them in regeneration. A bone graft provides the necessary space for the bone to regenerate completely. As the native bone grows, it replaces the graft material completely resulting in a new bone.

In many cases dentists require increasing the amount of bone in a patients jaw in order to be able to conduct dental implants.

Uses of Bone Grafting

Bone grafting is utilized in various procedures such as;

  • Ridge preservation after extracting teeth
  • Ridge augmentation
  • Ridge repair in case of failed implants
  • Sinus augmentation
  • Regeneration in periodontal defects

Advantages of Bone Grafting

When you lose teeth, it results in the weakening of the alveolar bone. After a tooth extraction, within the first three years there is a loss of nearly 40 to 60 percent of bone volume, after which the loss slows down to .25 to .5 percent.  The continuous loss results in many deformities such as chewing and speech difficulties, pain in the soft-tissues as well as muscle dysfunction. In addition, patient may not have the required bone support for prosthetic support. Bone grafting greatly eliminates all these problems. It not only improves the aesthetics but also helps in the proper functioning of the crowns, dentures and implants. It also helps to eliminate future bone-loss related problems. Our outside skin is supported by our jaw bone network. Improper jaws without the bone can cause our face to look prematurely aged.

Classifying Bone Grafts

Bone grafts are classified based on their materials and the source from where they are derived.

  • Autografts: The graft material comes from the patient itself, usually from another surgical site. This is the safest as it is the only osteogenic material. The bone is usually harvested from non-essential bones such as iliac crest, from the chin area or anterior mandibular ramus. The only negative side effect of this graft is that another surgical site is required. But this kind of graft is most preferred as there is less risk of graft rejection.
  • Allografts: Here the material comes from another patient, usually a cadaver. Extensive processing is undertaken in order to eliminate any antigenicity as well as disease transmission. It is usually sourced from bone banks. There are typically three types of allografts;
  • Fresh or fresh frozen
  • Freeze dried bone allograft
  • Demineralized freeze dried bone allograft
  • Xenografts: these grafts have their origin other species other than human, usually bovine or procine. This material too undergoes extensive treatment in order to avoid any disease transmission. Xenografts are slower to resorb and are osteoconductive.
  • Alloplasts: These are synthetic in nature and consist of materials such as tri calcium phosphate or hydroxylapatite which is also found in the bones. These materials are free from antigen and have no risk of disease transmission. They are osteoconductive as well as hard, like a bone and are easily accepted by bones. Initially calcium carbonate was being used but its use decreased since they resorb completely in a short time thus making the bone easy to break.
  • Growth Factor: Using recombinant DNA technology, growth factors enhanced grafts are produced. They may either contain Human Growth Factors or Morphogens.

Healing after Bone Graft

Like any surgery, bone grafting too requires time to heal. Post- operative care should be taken or else it may lead to infections and swellings.

Immediately after the surgery the following precautions should be taken by the patient;

  • The gauze should be kept on the surgical area minimum for half an hour after the surgery
  • You should not rinse your mouth vigorously nor should you touch it often.
  • Take the prescription drugs immediately if you feel any discomfort.
  • Place icepack on the side of the face where the surgery was performed in order to relieve pain and swelling
  • Restrict activities after surgery.

There are many factors which affect the healing process after your dental bone graft, they are as follows;

  • The number of missing walls
  • Area where the surgery is performed, upper or lower jaw
  • The type of bone material used for bone grafting
  • Type of membrane
  • Type of graft, Block or particulate
  • What is being rebuilt, height or width
  • Concurrent gum graft

Post-Operative Information

  • Numbness in the chin, lips and tongue is commonplace.
  • After surgery, a slight rise in temperature is expected. If the fever persists, you must consult your periodontist for the same.
  • While lying down and resting, take care of your position as pressure should not be applied on the side where surgery has taken place
  • You may feel hard projections in the mouth, do not mistake them for roots; in fact they are bony walls which supported the tooth previously.
  • Corners of the mouth and lips may dry out, keep them moist always.
  • You may experience sore throat as well as difficulty in chewing since the muscles are swollen.
  • You may experience stiffness of the jaw muscles which might make it difficult to open which is normal after the surgery.
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