Major and Minor Bone Grafting

Over a period of time, the jawbone associated with missing teeth atrophies or shrinks. This often leaves a condition in which there is poor quality and quantity of bone suitable for the placement of dental implants. In the past, these patients were not candidates for placement of dental implants.

Today, we have the ability to grow bone where needed. Summit Oral & Maxillofacial Surgery has invested a great deal of effort to acquire the most current techniques and equipment to accomplish bone regeneration. 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 facial appearance.

Major Bone Grafting

Bone grafting can regenerate bone where inadequate bone structure exists due to previous extractions, gum disease, advanced age or injury. The bone is obtained from a bone bank or your own bone is taken from the jaw, hip or tibia (below the knee). Special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone or tissue regeneration.

Major bone grafts are typically performed to repair large bony defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The hip (iliac crest) and lateral knee (tibia) are common donor sites. These procedures are routinely performed in our in-office operating rooms and they typically do not require hospitalization.

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 bone beneath the sinus is very thin, it is impossible to place dental implants here.

There is a solution and it’s called a sinus graft or sinus lift. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the bottom of the sinus. Keep in mind that the bottom of the sinus is the top of the upper jaw. After several months of healing, the bone becomes integrated 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 and the bottom of the sinus is available to adequately stabilize the implant, sinus augmentation and implant placement can sometimes be performed as a single procedure. If not enough bone is available, sinus augmentation will have to be performed first. Once the graft has matured, the implants can be placed.

Ridge Expansion

In severe cases where the bony ridge has resorbed, 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 then be placed and allowed to mature for a few months before placing the implant.

Nerve- repositioning

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 is indicated when teeth are missing in the back portion of the lower jaw. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates very slowly, if ever), usually other, less aggressive options are considered first.

To accomplish this procedure, an outer section of the lower jawbone is removed in order to expose the nerve. We then isolate the nerve and vessel bundle in that area and move it gently to the side. At this same time we place the implants. The nerve is then released and placed back over the implants. The surgical access is filled with bone graft material of the surgeon’s choice and the area is closed.

Additional Information

These above procedures may be performed separately or together, depending upon the individual's condition. As stated earlier, there are several areas of the body that are suitable for obtaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, including the area of the chin, the third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be obtained from the hip or the outer aspect of the tibia at the knee. When we use the patient’s own bone, we generally achieve better results.

In many cases, we can use allograft material or banked bone for dental implants. This bone is prepared from cadavers and used to stimulate the patient's 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. We even use healing factors from your own blood to accelerate and promote bone formation in graft areas.

These surgeries are performed in our fully accredited surgical suites under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.