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 that 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 that we use in our practice.  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.  Common donor sites for bone grafting include the iliac section of the pelvis, the chin and the posterior third molar areas of the jaw.  If large amounts of bone need to be harvested, the hip or the shin bone (tibia) is generally used.
  
  
• Allograft –  Bone obtained from a bone bank (cadaver bone). The bone is treated and processed in a bone bank facility. It provides a scaffold for your own cells to grow into, and over time, it will turn into your own bone. A secondary donor site is not necessary for this graft. 
  
  
• Xenograft – This is the implantation of bovine (cow) bone. A xenograft is perfectly safe and has been used successfully. A secondary donor site is not necessary. This graft is able to maintain space well.

Reasons for bone grafting

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

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 jawbone to be effective.  If the jawbone lacks the necessary quality or quantity of bone, bone grafting can strengthen and thicken the bone at the implant site. Sometimes, we need to do both bone grafting and gum grafting to create an ideal site for implant placement. 

Sinus lift – A sinus lift entails elevating the sinus membrane and grafting bone onto the sinus floor so that implants can be securely placed. A bone graft is often placed into the space in order to prevent collapsing of the moved membrane, and it allows your body to turn the space into your own bone over time. 

Periodontal Regeneration – Sometimes, when individuals have lost bone around their teeth, we are able to grow the bone back. This is only practical in certain situations, and not all periodontal defects are able to be grafted. However, when we think it will be predictable, we can often put a bone graft around teeth and grow back some of the bone that has been lost. 

What does bone grafting treatment involve?

Bone grafting is a fairly simple procedure that can be performed under local anesthetic; however, if large amounts of bone area need to be grafted, sedation may be recommended for your comfort. This is entirely based on patient preferences, but we are happy to discuss these options with you during your appointment. 

Initially, the grafting material needs to either be harvested or prepared for insertion.  A small incision is made in the gum tissue and then gently separated from the bone.  The bone grafting material is then placed at the affected site.

The bone regeneration process may be aided by:

• Gum/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 fibers.  This means that bone cells can migrate to the protected area and grow naturally. Typically, we will use donor bone and membranes for this process.
• Tissue stimulating proteins – Enamel matrix proteins occur during natural tooth development, and they can help stimulate the formation of the peridontal attachment between bone and the tooth. Please see our Patient Information about periodontal disease to view how the tissues attach to the tooth. Tissue stimulating proteins help create lost support in areas affected by periodontal disease.
  
• Platelet-rich growth factors – A high platelet concentration liquid can be used to create a blood clot at the site of a wound.  It has recently been shown that PRGF also stimulates bone growth – meaning a denser graft in a shorter time period.

The gum is sutured in place and a follow-up appointment will need to be made within 10 days to assess progress.

If you have any questions about bone grafting, please ask your dentist or give us a call.