Bone Grafting

Periodontal disease is the leading cause of bone loss in the oral cavity, though there are others such as ill-fitting dentures and facial trauma.  The bone grafting procedure is an excellent way to replace lost bone tissue and encourage natural bone growth.  Bone grafting is a versatile and predictable procedure which fulfills a wide variety of functions.

A bone graft may be required to create a stable base for dental implant placement, to halt the progression of gum disease or to make the smile appear more aesthetically pleasing.

There are several types of dental bone grafts.  The following are the most common:

• Autogenous bone graft – In this type of graft the bone is removed from elsewhere in the body and implanted in the mouth. The most common donor site for autogenous bone grafting is the posterior third molar areas of the lower jaw. 
  
  
• Allograft – Allograft refers to Human derived donor bone and is routinely used in periodontal and dental implant reconstruction. It is sourced from reputable tissue banks that undergo strict processing and sterilization procedures.
  
  
• Xenograft – Xenograft refers to bone graft material derived from another species. In dentistry the most commonly utilized xenograft is bovine bone.  A xenograft is perfectly safe and has been used successfully for many years.  Ample bone can be obtained and no secondary donor site is necessary.

Reasons for bone grafting

There are a wide variety of reasons why bone grafting may be the best option for restoring the jaw bone.

Dental implants – Implants are the preferred replacement method for missing teeth because they restore full functionality to the mouth; however, implants need to be firmly anchored to the intra-oral bone to be effective.  If the intra-oral bonelacks the necessary quality or quantity of bone, bone grafting can strengthen and thicken the implant site.

Sinus lift – A sinus lift entails elevating the sinus membrane and grafting bone onto the sinus floor so that implants can be securely placed.

Ridge augmentation – Ridges in the bone can occur due to trauma, injury, birth defects or severe periodontal disease.  The bone graft is used to fill in the ridge and make the intra-oral bone a uniform shape.

Nerve repositioning - If the inferior alveolar nerve requires movement to allow for the placement of implants, a bone grafting procedure may be required.  The inferior alveolar nerve allows feeling and sensation in the lower chin and lip.

What does bone grafting treatment involve?

Bone grafting is a surgical procedure which may be performed under local anesthetic but often involves IV sedation.

Initially, the grafting material needs to either be harvested or prepared for insertion.  A small incision is made in the gum tissue and the soft tissues are gently separated from the bone.  The bone grafting material is then placed at the effected site. A collagen membrane is routinely used to help secure and stabilize the bone graft. This product aids in the formation of good quality bone. The overlying soft tissues are then carefully and securely closed to ensure rapid wound healing.

The bone regeneration process may be aided by:

• Guided bone/tissue regeneration – A thin barrier (membrane) is placed below the gum line over the grafting material.  This barrier creates enough space for healthy tissue to grow and separates the faster growing gum tissue from the slower growing bone.  This means that bone cells can migrate to the protected area and grow naturally.
  
  
• Tissue stimulating proteins – Enamel matrix proteins occur during natural tooth development.  Emdogain is a matrix protein product which is usually placed on the affected site before the gum is sutured.  It mediates the formation of accellular cementum on the tooth which provides a foundation to allow periodontal attachment to occur.  Tissue stimulating proteins help to create lost support in areas affected by periodontal defects.
         

The overlying gums are sutured in place and a follow up appointment will need to be made within 10 days to assess progress.  Bone grafting is a highly successful treatment and a good base for further periodontal restorations.

If you have any questions about bone grafting, please ask your periodontist.