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Dental implants have become highly utilized in dentistry. Oftentimes, another procedure called a bone graft, is required to aide in the stabilization of  dental implants. The success of dental implants depends on the quality and quantity of bone present. If the bone is of poor quality or low quantity the dental implants have a much lower chance of success. Adequate bone structure is required for a dental implant to integrate (become one with the surrounding bone), and be strong enough to chew on. Bone grafting is a surgical procedure that can increase the quality and/or quality of the bone to then directly effect the chance of dental implants success. Not all dental implants require bone grafts, so when do you need them?

When Are Dental Bone Grafts Needed For Dental Implants?

-The existing bone has insufficient width. This could be a genetic factor where the bone width is lacking naturally or it could be from damage over time from periodontal disease.

-The existing bone has insufficient height. The height of the bone is just as critical as the width as it ensures the dental implant is properly anchored to support the stress of function (biting and chewing food).

-The maxillary sinus is too close to area of placement. This usually means that there is not enough bone between the tooth area and the sinus. Generally this can be fixed by lifting the sinus membrane (Sinus Lift) and placing bone graft material.

-Inadequate bone as a result of previous tooth or teeth removal. Sometimes when teeth are removed or fall out, bone can be removed as well. The bone will also decrease and remodel once the tooth is removed as it no longer is needed to hold a tooth in place.

-Not enough bone due to periodontal disease or trauma. Periodontal disease and trauma can lead to there not being enough bone for a successful dental implant.

-Inadequate bone due to defect in development that affects growth of bone in the jaw.

-Insufficient bone caused by the removal of cysts or tumors in the mouth. If the removal of a cyst or tumor is required there will also be removal of some of the bone, there may not be enough left for the dental implant to be successful. After removal of oral pathology, healing time is required so that bone quality and quantity can be reevaluated.

Bone Grafting Procedure

Where Does the Bone Come From?

Bone grafting procedures involve the use of your bone, cadaver bone, cow bone, and synthetic bone. Your own bone will most likely come from your chin or ramus (the back part of your lower jaw). If your dentist is unable to get enough bone from either of these areas, they may need to get bone from your hip or shin bone (tibia) instead. The hip is considered to be a better source because the hip bone can provide a large amount of bone. The marrow from either the hip or shin (tibia) contains bone-forming cells. However bone taken from your hip requires a visit to the hospital along with general anesthesia. Cadaver bone and cow bone is sterilized and broken down into small chips for easy placement.  Man made synthetic materials are also widely used for bone grafting. The synthetic bone acts as a scaffold for new bone to build on.

Newer products containing growth factors have also been developed.  Some are used to enhance bone graft materials and others are used in place of bone grafting. One of these products, BMP-2 stimulates certain body cells to turn into bone. The BMP-2 protein occurs naturally in the body.

What Happens During Bone Grafting?

A good example is a patient that needs to have a single tooth extracted and wants to have it replaced with a dental implant and dental crown. There may be a bone defect in the area or the tooth is large and needs to have some bone placed to fill in the expansive space. In this case, a dental bone graft is ideal and necessary to support the future dental implant.

Before the procedure, you will need to have either a CT scan or a cone-beam computed tomography (CBCT) scan. The images of a CT or CBCT provide valuable information about bone quantity and show where important nerves and sinuses are located which need to be avoided. A CBCT actually provides a 3-D image of your bone and any defects present. Local anesthesia will be used to numb the area where the bone augmentation is needed (called the recipient site) as well as the area from where bone will be removed (donor site) if using your own bone. An incision in the gum tissue where the implant will be placed is made to determine how much and what type of bone is needed.

The most common type of graft is called a socket graft. This is used to fill the space left behind by the lost tooth. The material used most often in a socket graft is often comprised of cow bone. This bone is harvested from known healthy cows and is processed through a freeze drying procedure that renders a sterile end product containing only the mineral content of natural bone. The graft is applied to the empty hole immediately after a tooth extraction and is secured using sutures (stitches).

Following the bone grafting procedure the patient will be given antibiotics, pain medicine, and an antibacterial mouthwash. You will need to avoid certain foods. You also will be told how to avoid putting pressure on the area or damaging it while it heals. If you wear a denture, you may not be able to wear it for a month or longer while the area heals. If you have natural teeth around the bone graft, your dentist may make a temporary removable bridge or denture to help protect the area.

Success of Bone Grafting

The success rate for bone grafts in the jaws for the purpose of placing dental implants is very high. However, there is a small chance that the bone graft will fail, even if your own bone was used. Bone grafts are not rejected like organ transplants. It is not exactly known why some dental grafts fail. There is a higher risk of failure in patients with diabetes, who smoke, or have periodontal disease. A failed graft can be removed. Once the area has healed, your dentist may choose to place a second bone graft.

Dental Bone Grafts Conclusion

Without dental bone grafts many would be unable to restore their smiles with dental implants. Just like dental implants, dental bone grafts are highly successful procedures to restore a smile to its natural state. Every case is different and the need for bone grafting varies from person to person and tooth to tooth. You can discuss the need for possible bone grafting with your dentist to see if it would benefit your procedure.

 

Dental implants have changed the way both dentists and patients look at tooth loss. One of the major advantages of dental implants is their longevity. The more traditional treatments like dental bridges generally last anywhere between 10-15 years or so. While dentures can last longer but need constant adjustment. Dental implants with proper care can last a lifetime.

How To Care For Dental Implants?

Dental implants can fail for any number of reasons. The usual culprits can include periodontal disease, poor dental hygiene, and smoking. Dental implants are considered to be a failure if they show any movement at all. This movement can occur when the bone and gum tissues surrounding the dental implant break down.

Listed below are a few simple steps you can do to help protect the stability of your dental implants:

-See Your Dentist Regularly For Routine Examinations And Professional Cleanings.

-Maintain Dental Hygiene. This should include brushing at least twice a day and flossing at least once per day.

-Use An Antibacterial Moutwash. This will diminish the amount of harmful oral bacteria in the mouth.

Factors That Lead To Dental Implant Failure

-Failed Integration of Dental Implants - This occurs when the bone of the jaws does not grow and fuse between the threads of the dental implant. This fusion between the bone and dental implant is called osseointegration. If osseointegration does not occur, the dental implants will become loose, or come out completely. To reduce this risk, your implant dentist will evaluate the quality and quantity of the jaw bone prior to surgery. This will allow the implant dentist to only place dental implants in areas where there is an increased success rate. If osseointegration does not take place, the dental implants can be removed, and implant surgery can be tried again following complete healing of the area.

-Dental Infection (peri-implantitis) –  While rare, this is the most common complication of dental implant surgery. The surrounding bone and gums can get infected during or after the placement of the dental implants. This can happen due to poor surgical technique, a contaminated implant, poor healing ability (diabetic, smoker, osteoporosis medications). The most likely time for this to occur would be during the surgical placement of the dental implant into the bone. Implant infection is a condition referred to as peri-implantitis. Peri-implantitis is characterized by inflammation or swelling of the tissues surrounding the dental implant. Peri-implantitis can also show up as a secondary infection later on. It is a form of periodontal disease that can lead to inflammation, bone loss and implant failure if not treated quickly and properly. Although dental implant infections are usually caused by the presence of bacteria during or immediately after the oral surgery for the placement of the dental implants, an implant infection can occur months or even years after the dental implants are placed.

-Damage To Surrounding Tissues - Dental implant complications related with surgical errors affecting adjacent teeth, nerves or sinus are directly connected to the experience and skills of the implant dentist. An implant dentist with the proper skill and experience is able to identify potential problems by examining x-rays or CT scan (computer tomography), design the proper treatment plan (including ideal location and angle), and execute it properly without complications. Even with the most experienced implant dentist there is always a possibility of dental implant complications. It is important to note that with experience comes an understanding of what can happen. This is important because an experienced implant dentist will be able to easily handle any complications that might come up either at time of surgery or afterwards.

What About The Dental Restorations?

Following placement of your dental implants and proper healing your dentist will place a dental restoration on top of them. These restorations can include dental crowns, dental bridges, and dentures. These restorations will eventually wear down from the constant mechanical forces placed on them through biting and chewing. Fortunately, these dental restorations will last years before needing replacement.

Dental Implants Longevity Conclusion

It is important to note dental implants can be a complex procedure requiring the need for an experienced implant dentist.In order to ensure the best possible outcomes, you should always work with a highly skilled and experienced implant dentist who makes dental implants a primary focus of their practice. With regular dental care maintenance, your dental implants could and should last a lifetime.