An important requirement for synthetic materials is to be biocompatible, that is to not inflict any damages on the human body, not cause any tissue reactions, and their dissolution not result in any toxic by-products. Bone grafting materials are mostly supplied as blocks or granulates. Materials are mixed with normal saline solutions, blood, or bone granules before being applied into the bone defect.
Bone replacement surgical techniques:
The decisive factor is the amount of bone deficiency, which is determined by our oral surgeon at the first consultation via X-ray and dental CT imagery, after which the treatment plan is drafted based on the data received.
If an implant may not be performed directly after tooth removal, bone replacement materials are ideal to fill the cavity remaining from the tooth extraction. They help form bone tissue, which in turn will be suitable for performing the implant.
Bone grafting concurrently with implantation
Bone grafting is done concurrently with placing the implants. IN such cases, there is only a minimum amount of bone mass to replace.
The process of bone grafting:
The intervention is done under local anaesthesia, but at your request it can also be performed in anaesthesia. We make inspections by X-ray and CT, then apply bone grafting materials to the surgical area and cover the surface with an absorbable membrane. We unite gum edges with non-absorbable stitches, which are removed in approximately seven days. Recovery time after a bone grafting surgery is 8 months, while the implanted grafting material ossifies with its surroundings and becomes part of the body. In the two-step process, the dental implant surgery can only take place after this phase is completed. It is another 3-6 months after the surgery until the implants settle within their environment. Complete ossification of the implant is than followed by the construction of the dental structure (dental crown, bridge, plated tooth replacement).
The intervention may be lengthy, but if you adhere to medical recommendations, it is well worth it. At the end of the treatment you will have regained your perfect, healthy smile.
Bone grafting 8 months prior to implant – Two-step process
n cases when a long time has passed between the tooth extraction and dental rehabilitation, we usually face serious bone loss. The bone to be grafted is so substantial that synthetic materials alone would not suffice, so we need to use the patient's own bone. In the lower jaws: the facial nerve runs backwards from the fourth tooth in the bone channel within the jaw. It may happen, especially after a lengthier time with missing teeth, that the bone supply is not high or wide enough to host the implant. To increase the width of the bone, if synthetic bone grafting materials are not enough, we use a bone cylinder or bone block.
Most often these are acquired from the following locations:
- the area in the chin below the lower incisors
- the mandibular angle
- the bone behind the upper second molars
- rarely from the posterior area of the hip bone or from the tibia below the knees (in anaesthesia, in a hospital setting)
he bone extracted by one of the above procedures will be transferred to the area where bone grafting is required. The secure the prepared block or cylinder with screws and cover it with a membrane. Fastening screws are removed in 4-6 months at the implant process. Places used for bone extraction are always filled up with bone replacement materials and covered by a special membrane. In time, the replacement material is transformed into the patient's own bone and the membrane dissolves. In case of the upper jaw, often the bone supply between facial cavity and the bone surface at the oral cavity is insufficient. In such cases, we perform the lifting of the facial cavity base (sinus lifting). The sinus cavity is located in the area above the small and large molars. By losing the molars, the bone tissue deteriorates, and with age the sinus cavity also expands, resulting the thinning of the bony wall of the facial cavity. The method of "sinus elevation" was developed to thicken this bone.
In essence: after making an incision on the gum, we reveal the thin bony wall of the sinus where we open a small window, the size of 1 x 1.5 cm, lift the mucous membrane of the facial cavity and place bone grafting granulates underneath in a width of about 1 cm.
After a rest period of 8 months a bone suitable for stable implant is developed. We apply this technique at a clinic as a matter of course.
The prevailing reason for loss in bone mass is the removal of teeth. After removal, the bone tissue in the jaw where the tooth or teeth used to be will start to waste away sooner or later. The reason for the atrophy is the lack of mechanical stimulation: without teeth, the bone mass around the roots will not be burdened by chewing and the unused area will start to deteriorate. After years, a significant amount of bone loss will occur where teeth have been removed, and the height and width of the bone will also decrease. A bone mass that used to ideal wastes away into a shallow, thin bone plate. Of course there are also pathologies (periodontal diseases, osteoporosis) where bone mass will decrease.
This makes it difficult or impossible to ensure the stability of removable full dentures, while dental implants are also not possible to perform. Regeneration of the bones may be facilitated by systemic treatment, or locally by implanting bone replacement materials. For a dental implant to work, we need at least 6 mm of bone "width" and 8-10 mm of bone "height". Bone replacement may be done by using bone replacement material, which are sterile, safe tissue-friendly materials, or by using the body's own bones if necessary. The intervention may be performed concurrently with placing the implant or prior to the placement by lifting the mucous membrane of the facial cavity (called 'sinus lift" surgery). This is a technique that has been used safely for many years to increase the height of the bone.
Materials used for bone grafting:
- Own bone: excellently facilitates the regeneration of thinned-out bones, The disadvantage is that yet another surgery is necessary for the extraction, which may be uncomfortable for the patient: side-effects may occur and the intervention is more costly in money and time.
- Using bones from third parties is not yet a practice in Hungary.
- Animal bones: We have several materials for use at our clinic, most often we apply the products of the Swiss firm Geistlich.
- Synthetic bones: These include some very widely used materials, such as tricalcium phosphates and hydroxyapatites.