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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.

 

Use of an anti bacterial mouthwash can be an important part of everyone’s dental hygiene. Many people have been instructed to brush and floss regularly but did you know that using an anti bacterial mouthrinse can be just as important? Walking down the aisle of any grocery or drug store can be quite confusing as there are a ton of options.

Types Of Mouthwash

-Therapeutic Mouthwash. This type of mouthwash is meant to fight off dental diseases like tooth decay and periodontal disease. These will have anti bacterial and anti plaque (tartar control) properties. By reducing plaque and tartar you will decrease the risk of periodontal disease as well as decrease gum inflammation. They may also contain fluoride which will help in the fight against tooth decay.

-Cosmetic Mouthwash. These include agents to freshen your breath. They can also include whitening agents. Generally, these mouthwashes do not include any therapeutic agents.

Therapeutic Mouthwash Advantages

-Mouthwash With Fluoride. Fluoride mouthwashes have the ability to possibly help decrease the risk of tooth decay. There have been numerous research studies over the years to prove that fluoride can strengthen and reduce the breakdown of enamel thereby reducing the possibility of tooth cavities. This will not work for all but has been proven to be a benefit for many. Some fluorides are also good antibacterials and help fight periodontal disease (example – stannous fluoride).

-Periodontal Disease Fighter. Periodontal disease is caused by plaque from bacteria and food that sticks to teeth. As the bacteria feed on the food particles they release acids that will break down the bone and cause inflammation of the gum tissue. Our body responds and causes bone loss and inflamed, infected gums. An antibacterial mouthwash may help prevent periodontal disease by decreasing the amount of bad bacteria in the mouth. There is also type of rinse (Periogen) that has been found to dissolve tartar, stains, and plaque. This rinse is a great way to keep your teeth from rebuilding tartar between cleanings. This is a powder that can be diluted with water in a waterpik and tends to be even more effective if a capful of your fluoride rinse is added to it.

-Help Keep Pregnancy Gingivitis At Bay. It is important to maintain good oral hygiene at all times but for certain groups it is even more important. For pregnant women it can be critical to control oral health. During pregnancy, a woman’s hormones are elevated which makes them more susceptible to developing periodontal disease if their dental hygiene is not maintained. Periodontal disease in pregnant women has been linked to low weight and pre term babies.

-Help Diabetics. Patients with systemic diseases that make them more susceptible to infection like diabetics need to reduce the bacteria they are ingesting. It is even more critical to maintain good oral hygiene and mouthwashes are definitely recommended for those patients.

Therapeutic Mouthwash Disadvantages

-Canker Sore Irritant. This is caused when the alcohol content in your mouthwash is too high. It will irritate the canker sore and make it quite uncomfortable to use.

-Cover Up For Bad Breath. Use of a mouthwash can definitely lead to fresher breath but it is usually only for a short period of time. Only some mouthwashes are formulated to actually neutralize odor causing chemicals (example Closys). Not maintaining your dental hygiene, or chemicals from your diet are usually the underlying factors in most people’s bad breath but the mouthwash will just mask it for a short time.

-Alcohol Based Mouthwash. Studies (Listerine) have shown that rinses with alcohol, if used as directed can actually cause saliva production to be stimulated in a semi dry mouth. The alcohol in mouth rinses has historically been used as a way to cause the essential oils (the bacteria killing aspect) in the rinse to keep from separating out in the liquid, and staying mixed. No one wants to rinse with something oily feeling. There are now quite a few alternatives to alcohol to do the job, so alcohol free rinses have become more prevalent. Many people do not like the burning sensation of alcohol, and in people with little to no saliva flow, alcohol based rinses can be quite uncomfortable. The choice is based on personal preferences.

Mouthwash Use Conclusion

Using a mouthwash can be another tool to keep your mouth healthy and free of periodontal disease. If you decide to use a mouthwash as part of your dental hygiene routine remember to continue brushing and flossing as well. They work together not separately. There are a lot of mouthwashes on the market today, talk to your dentist to see which one is right for you.

 

Periodontal disease is a progressive disorder that if left untreated will worsen over time. Many people simply ignore the warning signs or just do not know them. Educating yourself on the signs and symptoms of periodontal disease is a good first step to taking control of the disease and it’s progression.

What Is Periodontal Disease?

Periodontal disease (or gum disease) is a serious and chronic infection of the gum tissue that can result in the staged breakdown of the tissue and the deterioration of bone that surrounds and supports your teeth. This infection process begins when bacteria and plaque form a sticky bio film on your teeth. Biofilm causes a chronic inflammation of the gum tissue.  Periodontal disease will continue to progress if the biofilm is not reduced or removed.   Maintaining proper dental care and hygiene are the most important steps in prevention and halting of the disease. Periodontal disease is the leading cause of tooth loss in adults. Studies show that somewhere between 75% and 95% of all adults are suffering some stage of periodontal disease.

The stages of periodontal disease include:

-Gingivitis ( inflammation of the gum tissues). This is the initial stage of periodontal disease. This is easily reversible and is the mildest form of periodontal disease. Symptoms include red, swollen (or puffy) and inflamed gums due to plaque-bacteria build-up. The gums may also bleed easily during brushing or eating of hard foods. During this early stage of periodontal disease, the process can be reversed with at home dental hygiene and professional cleanings to remove the biofilm, and tartar. Most of the people with this early form of periodontal disease, do not even know a dental problem exists. This is a crucial period for the patient, as the condition can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been affected) at this point if it is recognized and properly treated. Gingivitis is commonly seen during puberty, pregnancy, times of high stress, and menopause, as hormones can make you more prone to inflammation. As for the rest of the population, poor hygiene is generally the most common cause, followed by medication and certain medical conditions.

-Periodontitis. As the disease state progresses, it is now becoming harder to treat and manage. The difference between gingivitis and periodontitis is that gingivitis only infects the gum tissue that surrounds the teeth while the periodontal disease process also invades the bone that provides support and stability for the teeth. The bacteria eventually invades past the initial the gum line area and destruction begins to the point that gums may begin to separate or pull away from the teeth (taking away support and connective fibers with it). What results are called periodontal pockets. These pockets allow for bacteria to invade below the gum line.  They eventually become loaded with toxic plaque and bacteria that moves and works its way deeper. It begins to erode the bone and connective fibers below the gum line. A patient’s bite will be affected (as the teeth shift or loosen) by the lost support which then affects chewing and other functions.

-Advanced Periodontitis. As the periodontal disease process advances further, the fibers and bone that provide support for the teeth are destroyed. At least half of the bone support (if not more) will have broken down at this late stage of periodontal disease. It does not grow back naturally. Teeth may begin to loosen. Deep root cleanings and surgical intervention are typical at this stage. This may include cleaning with a periodontal microscope, (Perioscope), grafting of tissue, bone, placement of growth factors, (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open flap surgery, and, possibly tooth removal.

Periodontal Disease Warning Signs

-Puffy, Swollen Gum Tissue. This is a hallmark sign of gingivitis and periodontal disease in general. Your body’s natural response is to fight off this infection caused by excessive untreated debris. It does this by bringing healing components to the area through the blood vessels. The gums will remain this way until the irritant is removed namely the plaque and bacteria building up on your teeth and below the gum line.

-Bleeding Gums. Once the tissues are puffy and receiving extra blood flow to fight off the disease process. This leads to inflamed gum tissue that will bleed easily upon brushing or even eating.

-Presence Of Periodontal Pockets. As the disease process progresses and the bacteria and plaque build up the gum tissue will begin to separate from the teeth creating ever larger pockets where bone will be lost. These pockets become very difficult to clean on your own and necessitate further professional help.

-Infection And Pus. Once there has been significant advancement of pockets, bleeding ends, and infection begins. Pressing on the gums, flossing or probing by the hygienist tends to release pus into the mouth.

-Long Looking Teeth. As we lose bone support, the gum tissue falls back and exposes the root of the tooth. This gives the appearance of longer teeth.

-Persistent Bad Breath. While this can be a sign of other more serious medical conditions it is a hallmark of periodontal disease progression. Much of the odor has to do with the infection process, and tartar.

-Loose Or Drifting Teeth. Once periodontal disease has advanced, the support tissues are diminished. The further the advancement, the looser the teeth become.

Periodontal Disease Conclusion

Periodontal disease is a progressive disease. There are many signs and stages to help you to be aware of  it’s progression. The disease process involved in periodontal disease can be quite aggressive making it harder and harder to control and treat. It is best to stay ahead of that process by being diligent with at home dental hygiene and maintaining a regular schedule of professional cleanings.

Dental Implants were not always such a mainstream fixture in dentistry. There was a time when dental implants were for all practical purposes experiments in seeing what worked and what did not. In the last 15 years we have really entered a new age with dental implants being almost routine in their nature now. Most dentists cannot imagine a day without them anymore as a treatment for our patients.

Dental Implants are an artificial tooth root that a dentist, periodontist, or oral surgeon inserts into your jawbone to hold a replacement tooth or teeth(bridge). Dental implants are the perfect option for people with good oral health maintenance who are missing one tooth or multiple teeth due to periodontal disease, via trauma, or some other reason.

Dental Implants use the most modern materials that dentistry has to offer. Years and years of research have gone into the dental implants in use today. Dental implants are much more tooth friendly than traditional bridgework. Dental implants do not rely on neighboring teeth for support nor do the neighboring teeth need to be prepared to be part of the bridgework.

With optimal conditions and in the hands of a skilled dentist, dental implants can look as natural as your own teeth. Only you and your dentist would ever know you even have one. This gives patients the utmost in self confidence giving them the ability to broadly smile as well as eat as they choose. People missing teeth are generally self conscious about their smile and appearance. Following successful placement and restoration, dental implant patients can expect them to last a lifetime if they maintain good oral hygiene.

Modern dental implants can play a few roles in tooth or teeth replacement. These include:

-Replacement of one or more teeth without affecting the neighboring teeth.
-Act as support for a bridge. This will eliminate the need for a removable partial denture.
-Provide support and stability for a denture. Attaching a denture over dental implants make the denture more secure and comfortable. This is also called an implant supported overdenture.

Dental Implants and their advantages over Traditional Dentistry

-Cosmetics. When done properly dental implants will look and feel like your own teeth. Another plus is that since dental implants are placed directly in bone they prevent bone loss and gingival recession that happens over time in areas where teeth are missing. No one but you and your dentist will ever know you have a dental implant.

-Dental Implants allow conservation of tooth structure. Dental implants allow the dentist to save your adjacent teeth from preparations. A traditional bridge requires the preparation of neighboring teeth. Utilizing dental implants is a long term benefit to the patients dental health by saving their natural tooth structure.

-Self Confidence. The wonder of dental implants is that they allow patients to talk and eat full of self confidence. Dental implants offer security and freedom.

implant dentistry

Dental implants Diagram

-Highly Predictable. Dental implants have had a long track record of a very high success rate. Due to this they are an excellent option for tooth replacement.

Treatment

Any treatment for dental implants begins with a thorough examination to develop a proper treatment plan.  Without a good game plan the treatment will be doomed to fail.

As mentioned earlier, dental implants are ideal in the following situations:

-Single tooth replacement. Dental implants are an ideal option for patients with the quantity and quality of bone necessary to hold an implant. The dental implant will allow you to maintain the natural tooth structure of adjacent teeth while replacing a lost tooth.

-Multiple teeth replacement. Dental implants are also ideal in this situation. If you are missing several teeth, implant supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots.

-Replacing all your teeth. If you are missing all of your teeth, an implant supported full bridge or full denture (also called an implant overdenture) can replace them. This renders traditional dentures to the curb as dental implants used in this fashion will be more stable allowing patients to eat and talk as if they have their own natural teeth.

In some cases, patients will need help to allow for placement of dental implants. Luckily, modern dentistry has developed a few procedures to “help” patients along. These include:

-Sinus Augmentation.  Dental implants need a good quantity of bone along with good quality of that bone to succeed. The upper jaw is known to have poorer quantity and quality bone structure as opposed to the lower jaw. The maxillary sinus also plays a role in increasing difficulty in this area. Sinus augmentation can remedy these issues by raising the sinus floor and placing bone grafts in the area to aid in dental implant placement.

-Ridge Modification. When the bone is not 100% adequate for dental implant placement, dentists are able to make it perfect by performing a dental bone graft. A bone graft is the placement of bone in the jaw to to build it up. This gives an excellent platform for dental implants. Ridge modification has been shown to improve both appearance and long term success of dental implants.

Expectations of patient

Following placement of implants and restoration with crowns or dentures, patients can expect a life long restoration that will be stable and cosmetic. Just because these products are man made does not mean oral hygiene should be forgotten and neglected. Dental hygiene must be maintained at a high level if the patient wants to ensure these restorations last. Follow up dental visits are required just as if you had your own natural teeth. If dental implants are well taken care of the patient should expect them to last a lifetime!