Bone Grafting

Over time the jawbone connected with a missing tooth or teeth can atrophy or be reabsorbed. This can create conditions where the remaining bone is of subpar quality and quantity use dental implants. This means that most patients in this position not be able to receive dental implants. Fortunately now we have the capacity grow replacement bone where necessary. This opens up an entirely new avenue to place implants in the correct dimensions as well give us the ability to recover functionality and the esthetic appearance of teeth.

Major Bone Grafting

The process of bone grafting may be used to repair implant locations without the necessary bone structure for implants due to injuries, gum disease or damage and past extractions. The bone can be gathered from your own, jaw, hip tibia or from a tissue bank. Sinus bone grafts are sometimes utilized to replace damaged bone in the back of the upper jaw. Guided bone regeneration (or guided tissue regeneration) uses special membranes to dissolve under the gums and safeguard the bone graft from further damage as well encourage regeneration. The defects that these procedures resolve are often the result of serious traumatic injuries, congenital defects and tumour surgery. Larger defects are typically repaired utilizing the patient’s own bone mass from a greater variety of locations on their body. Procedures of this nature are performed an operating room and are followed by a hospital stay to effectively recover.

The Importance of Teeth for Jaw Bone Health

Missing teeth can cause the jawbone to be reduced at the location of the gap. This leads to a whole host of other problems, like issues with general health and appearance. Patients who suffer from these gaps will likely experience issues with your remaining teeth, pain, altered facial appearance, and after a long enough period the loss of the ability to speak and eat in a normal manner. This is why it is imperative that these issues are taken care of early on.

Bone tissue is maintained and strengthened by consistent use. Bone will atrophy just as muscles will. Natural teeth embedded directly in the jawbone and keep it active through consistent activities like chewing and biting. When a tooth or teeth are missing the stimulation that the jaw bone requires to stay strong is not there, and it starts the process of breaking down or being reabsorbed. The body views the jawbone as not being necessary and so it deteriorates.

Potential Consequences of Tooth and Jawbone Loss

• Problems with your other teeth, including but not limited to, drifting loosening, loss, and misalignment.
• The collapse of your facial profile
• Reduced lip support
• Skin wrinkling in and around the mouth
• Distorted facial features
• Temporomandibular joint (TMJ or jaw) pain, headaches, and facial pain
• Struggling to speak or communicate in general
• Nutritional issues caused by a poor diet due to an inability to effectively chew without pain
• Sinus expansion

Causes of jawbone loss and deterioration.

The following are the most common causes for jawbone deterioration and loss leading to the possible requirement of a bone grafting procedure:

Tooth Extractions:

The most common cause of jawbone deterioration that leads to bone grafting, are tooth extractions. Tooth extractions cause the gaps that lead to the unstimulated jaw and deterioration. The rate of damage will vary widely from person to person. It does on average start in the first eighteen months after an extraction, and its complications will continue throughout the rest of the patient’s life.

Periodontal Disease:

Another cause of jawbone loss is periodontal disease, which are continuing infections of the gums that, over time, destroy the support of the natural teeth. This disease affects and damages one or more of the periodontal tissues, gingiva, cementum, periodontal ligament or even the alveolar bone. There are many diseases that damage tooth supporting structures, the bulk of periodontal issues are caused by an inflammatory response created by plaque. They are split into two categories, periodontitis and gingivitis. Gingivitis being a less severe disease may never lead to periodontitis but it will always appear before.

Dental plaque is the main cause of gingivitis in those who are susceptible. Plaque is made up mainly of food particles and a variety of bacteria which stick to your teeth around the gum line. It is sticky film which is why it is able to adhere so effectively to teeth. It builds up quickly and irritates the gums. Gums will often become inflamed swollen, red and even bleed. If this happens over a long period of time the gums recede from the teeth and create pockets. Poor dental hygiene, neglecting to floss and brush on a regular basis can allow plaque time to harden into calculus otherwise known as tartar.

Periodontitis is caused by bacteria that attach themselves to the teeth in combination with an overactive immune response to that bacteria on the part of the body. If gingivitis is neglected and allowed to form into periodontitis the gum tissue that supports holds teeth in the correct location degrades. This leads to loss of the the jaw bone as well as tooth loosening and loss of teeth.

Dentures & Bridgework:

Dentures that are not fully anchored and sit on the top of the gum line will not provide the required stimulation to jaw leading to deterioration. Due to the fact that this type of denture needs the bone to stay held in place, over time as the bone is further damaged the denture will not sit securely and can cause problems with speech and eating. Over time a an entirely new set could be required to make the new fit. This is why it is important to take good care of your dentures, but repairing and refitting them when necessary to avoid other complications down the road.

There are dentures however that are supported by anchors at their base which are able to sufficiently stimulate the law bone actively helping to preserve it.

With bridgework the teeth that are located on both sides of the bridge have the necessary stimulation to keep the bone in good shape. However the gap that the bridge is spanning where the teeth are missing does not increase the risk of bone deterioration. A bone graft procedure will allow us to restore much of the lost bone function and growth, stopping the adverse effects of poor denture care.

Trauma:

Trauma is another leading cause of bone damage. If a tooth is lost or is damaged to the point that it no longer has a biting surface below the gum line the bone will become under stimulated and damaged. Commonly jaw and tooth trauma include, but are not limited to, teeth being knocked in an injury, or jaw fractures. Some teeth with a history of trauma may die and cause bone loss even years after the first trauma.

Bone grafting would be needed in order reverse the effects of serious bone deterioration. The goal of which being to restore function and promote further bone growth and in the specific area.

Misalignment:

Issues with one’s alignment can create the conditions where some teeth do not have an opposing tooth structure, which can over erupt causing jaw deterioration. Problems with Temporomandibular joints suffer from regular wear and tear and neglecting to receive treatment can create unusual physical forces that can hinder your teeth’s ability to chew and grind effectively. This can lead to the reduced levels of stimulation in the jaw that can lead to damage.

Osteomyelitis:

Osteomyelitis is a bacterial infection within the bone and the marrow itself in the jaw. Like many infections this can cause inflammation which places pressure and reduces the level of blood supplied to the bone. Treating osteomyelitis most time needs to be treated with antibiotics and even removing the bone itself. A bone graft procedure would then be done afterwards restore the bone growth and function that was lost during the removal.

Tumors:

Even non life threatening benign facial tumours can grow large enough to require the removal of a section of the jaw. A malignant mouth tumour will usually spread into the jaw which means removing part of the jaw. In both of those scenarios a reconstructive bone grafts is likely needed to restore function. It can however be much more difficult with patients suffering from malignant tumours as there may be cancerous tissue that requires extraction as well.

Developmental Deformities:

Certain syndromes and conditions commonly known as birth defects may need to be resolved with bone grafting. Birth defects in a dental context generally refer to missing portions of teeth, missing facial bones, and missing parts of the jaw or skull.

Sinus Deficiencies:

Removing molars from the upper jaw can have an adverse effect on maxilla (maxillary sinus). This is a result of air pressure in the Maxilla causing resorption of the bone that previously held the teeth in place. Sinuses then become enlarged leading to a condition known as a hyperpneumatized sinus. This takes years to develop and is often the result of inadequate bone for dental implants to be placed. We perform a procedure known as a sinus lift to treat the enlarged area.

What is Bone Grafting?

Over time the jawbone associated with missing teeth becomes under stimulated and as result atrophies. This provides suboptimal conditions for dental implants, due to poor the quality and or quantity of bone. It is conditions such as these that lead to bone grafts.

Bone grafts have advanced to the point where they are able to replace the bone where it is missing but also foster new bone growth in that very same location. This allows for new dental implants to be used and to restore function and appearance.

Types of Bone Grafts

Autogenous Bone Grafts:

Autogenous bone grafts otherwise known as autografts use your own bone from another location on your body generally from the chin, lower leg, hip, skull or jaw. The advantage of this type of bone graft is that it takes living bone, and thus features living cellular elements which helps promote further bone growth.

The major downside however is that it does require two procedures, one to harvest the required bone, and another to graft it. Depending on your specific condition it may not be ideal to go through two procedures.

Allogenic Bone:

An allogenic bone graft or allograft makes use of dead bone that has been harvested from a cadaver. The bone is then proceed using a freeze dry technique designed to extract the water using a vacuum. Unfortunately because the bone is no longer living it is not able to grow on its own. It instead works as a the structure base for other bone to grow over and fill the gaps.

Xenogenic Bone:

Xenogenic bone is bone harvested from non living bone in another species, typically a cow. Processing requires high temperatures to ensure that there is no immune rejection and contamination. Much like allogenic grafts this bone is used as a base for further bone to grow over and around.

Xenogenic and allogenic bone grafts do not need a second procedure in order to harvest your bone, making it ideal for some patients. They do not however foster new bone growth in the same way, as autografts do, leading to less predictable results and longer bone regeneration time frames.

Bone Graft Substitutes

If using real bone is not an option there are substitutes available. Synthetic bones can be created using a demineralized bone matrix/demineralized freeze dried bone allograft. This product is created from allograft bone, containing proteins collagen and the growth capabilities of allograft bone. It can be used as a powder, putty, chips or a gel that can be injected.

Graft Composites:

Graft composites are made of other bone graft substances and growth factors to again the advantages of many different substances. Some examples include:
– Collagen/ceramic composites – this closely simulates the composition of a natural bone. DBM is combined with bone marrow cells that create growth in the new bone or a collagen/ceramic autograft composite.

Bone Morphogenetic Proteins:

Bone morphogenetic proteins (BMPs) are proteins that are naturally produced in the body and regulate, foster growth in, and repair bones.

The use of Synthetic materials also means no need for a second procedure, since no bone needs to be harvested, greatly reducing the level of pain and risk experienced by the patient. All methods of bone grafting have their own risks and benefits which is why our doctors will determine which bone graft and which materials meet your specific needs.