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Bone Grafting

If you lose teeth, your jawbone no longer gets the daily stimulation that those teeth provided. Without this stimulation, new bone cells are not created and your body begins to reabsorb the bone. This can also occur if periodontitis disease is present as bone loss is a side effect of this advanced form of gum disease. Regardless of the reason, any type of bone loss eventually causes your face to start to take on a different look. This is the look that the elderly are so commonly known for, the 'sagging look,' giving your face a sunken in appearance.

The largest problem with bone loss is the inability to place dental implants to replace the missing teeth. If dental implants are not an option, you are generally left with dentures as your only choice. Today's technology has made it possible for us to help your bone grow back, allowing you to avoid any change to your facial features, making you a candidate for dental implants and to enhance your overall oral health with bone grafting.

In certain circumstances, bone grafting is also needed for jaw deformities. These deformities could be something you were born with, occurred as a result of an injury or is a side effect of the presence of tumors in the jaw. There are several major bone grafting procedures that can be performed, including sinus lift, ridge expansion and ridge augmentation.

How is Bone Grafting Performed?

Bone grafting is a procedure completed right in the office. We start by gaining access to your existing bone by creating an incision in the gums. Once access has been made, the graft is attached to the bone. The graft may come from you (your hip, jaw or tibia), a donor or it might even be synthetic. Once the graft is placed, your gums are stitched up and the process of building new bone begins.

Bone Grafting Procedures

In addition to making a patient eligible for dental implants, bone grafting can be used to treat jaw deformities or to help fight other issues occurring, such as a falling sinus cavity or loss of ridge height.

Sinus Lift/Ridge Augmentation
When the sinus wall is not sufficient enough to have adequate bone to hold a dental implant, a sinus lift is needed. During the procedure, the sinuses are lifted and a bone graft is added to support the lift, known as the ridge augmentation. The floor of the sinus cavity is the roof of the upper jaw, which then becomes the support for future implants. Once the bone begins to grow back and the sinus cavity is healed, the implants can be placed in the newly grown bone.

Ridge Expansion
When ridge height is lost due to bone reabsorption, an expansion is needed. The expansion helps to build up the bone and widen the jaw ridge, enabling you to be a candidate for dental implants.

Nerve Repositioning
Sometimes there is not enough room in your lower jaw to place dental implants. When this is the case, more room needs to be made through a procedure called nerve repositioning. This procedure typically needs to be done for replacement of the molars that are the furthest in the mouth, as well as the 2nd premolars. The nerve that gets moved is the inferior alveolar nerve, the nerve responsible for giving the chin and lower lip feeling. As you can imagine, this procedure is a serious undertaking that needs to be done at the hands of experts.

How Nerve Repositioning is Completed
The nerve first needs to be accessed, which is done by removing a small, outside area of the lower jawbone. Once access is gained, the nerve is isolated and pulled out to make room for the implants. The implants are immediately placed and the nerve is put back after the implants are complete. The surgical area then receives bone grafting, which as stated above, the material for the bone grafting can be obtained from your own body, whether the inside of your mouth, chin, or upper jaw area, or from a synthetic material which your body will quickly accept and use to promote bone growth. Once the bone graft is completed, the area is then closed up. In very rare cases, the two procedures (removing the nerve and placing the implants) are done separately, but this is determined on a case-by-case basis.

The nerve repositioning surgery is completed in a surgical setting and typically requires sedation, whether IV or general anesthetic. You will be able to go home immediately following the procedure, but you will be required to remain on bed rest for 24-hours and to limit your activity for the next 7 days.

Ridge Augmentation
In some cases of bone loss, the ridge is absorbed by the body. In order to ensure the success of dental implants, a bone graft is necessary in this area, whether in an attempt to make it wider or taller. The process is one that we complete often and with ease. During the procedure, we will open the area that requires the grafting with an incision in order to lift the gums. Once lifted, bone grafting material (whether your own or synthetic) is placed and the area is closed up and given time to heal.

In general, a ridge augmentation requires a form of anesthesia in order to ensure your comfort and the success of the procedure. We will discuss your options with you, whether IV sedation is suitable or if general anesthesia is required. You will be able to go home the same day of the procedure, but you will be required to rest for the entire day and take it easy for the week following the procedure.

Platelet Rich Plasma

Platelet Rich Plasma, otherwise known as PRP, is derived from a patient’s blood. Its use was originally refined to hospital use until recently, with the onset of new technology and the ability for doctors to obtain the appropriate number of platelets from just a small blood draw. Platelet Rich Plasma is so important because it accelerates the rate of healing that patients experience after oral surgery. The addition of platelets in the area of the surgery helps the body to naturally heal. This process normally occurs when there is a wound, but PRP furthers the ability of platelets to heal the area by encouraging the growth of new tissues, limiting the downtime that a patient experiences.

In addition to platelets, the PRP process also produces BMP, or bone morphongeic protein. This protein helps in the growth of new bone, which is crucial during the dental implant process. When implants are placed, the mouth goes through an extensive healing period, which includes bone growth and healing of the area. This process can take place over several months, but with PRP and BMP, the healing process is faster and the bone grows quicker, making the dental implant process even more efficient.

PRP is considered to be a very safe process as it is derived from your own blood. It is also considered convenient because it is obtained while you are already undergoing a procedure that will require healing, such as dental implants. Because the healing process is then faster, the entire process is more efficient and cost-effective for the patient. It has been used in many cases, including bone grafting to place dental implants and in repair of certain bone defects.

Platelet Rich Plasma FAQ

1.  How safe is platelet rich plasma? PRP is completely safe as it is the use of your own blood (a small amount). The blood collected is put through a centrifuge machine which produces the PRP. The entire process takes an estimated 15 minutes to complete.
2.  Is PRP always necessary for bone grafting? No. We will determine which cases require PRP and which do not, however, the process only helps the area heal, making it a process well worth having completed.
3.  Does insurance cover PRP? No. PRP is typically a charge that the patient must pay for on his own.
4.  Does PRP promote bone growth? No. PRP on its own does not promote bone growth - it needs to be done in combination with a bone graft material (whether your own or synthetic) in order to help with bone growth.
5.  Are there people that are not a candidate for PRP? Yes, but only a small few. Patients that have pre-existing blood disorders or hematologic diseases may not be eligible. We determine eligibility on a case-by-case basis.

Knowing what to Expect

Bone grafting is performed in the office under local anesthesia. In some cases, IV sedation can be used if necessary as well. After the surgery, you may feel some discomfort in the area of the incision as well as minor swelling. In general, over-the-counter ibuprofen and the application of a cold compress or ice can help to minimize these issues. After a day or two you will be completely recovered from the procedure and your bone will continue to grow back over the next few months. Once the area is completely healed, you will be able to receive dental implants, providing you with the stimulation your jawbone needs to continue to create new bone cells and stay strong.

Distraction Osteogenesis

Distraction Osteogenesis, otherwise known as DO, is a relatively new procedure to the dental world; however, it has been in existence for other areas of the body since the early 1900s. DO is the process of separating adjoining bones in the facial region through the use of a distraction tool. The tool is strategically placed to separate the bones and to promote new bone growth in that area.

The distraction portion of the procedure is completed in 3 phases: latency, distraction, and consolidation. The first phase, the latency phase, is a period of healing - nothing is done to the area as it naturally heals. Once the area is sufficiently healed, the distraction is started at a gradual pace through the activation of the tool. This can be likened to the procedure that is done when an orthodontic patient's braces are tightened. The final phase, the consolidation phase, is when the distraction tool is left in the mouth, but is no longer tightened. During this period, the bone continues to grow and becomes able to stand on its own.

Distraction Osteogenesis FAQ

1.  Is the surgery for Distraction Osteogenesis invasive? No. The DO procedure is completed as an outpatient procedure, most patients are home shortly after the procedure is completed with a very short recovery time.
2.  Does insurance cover DO? Many insurance companies do cover the DO procedure if it is proven to be medically necessary. As with any other procedure, however, it is important to check with your individual policy to see what your benefits are regarding this procedure. Our office is happy to help you determine your benefits for this procedure.
3.  Will I be in pain during Distraction Osteogenesis? The answer is twofold. During the actual procedure, you will not be aware of what is going on as you will be under anesthesia. After the surgery, we will provide you with appropriate medication to minimize the pain as well as to avoid infection. The activation of the distraction tool may be uncomfortable, but it is typically well tolerated by most patients.
4.  Are there benefits to Distraction Osteogenesis? When DO is compared to traditional surgery, the benefits are numerous including the elimination of swelling and pain following the procedure. In addition, there is no need for bone grafts, eliminating yet another surgery. In general, DO is considered to provide more stable results too.
5.  Are there disadvantages to Distraction Osteogenesis? The largest disadvantage of the procedure is the frequency that you must visit the office in order to ensure that infection did not settle in as well as to learn how to use the tool.
6.  Can DO eliminate the need for a bone graft in the jaws? Yes, DO can even be performed in the jaw area as recent technological advances have made it possible to use the DO device to grow bone that has been lost in the jaw areas, making you a good candidate for dental implants down the road.
7.  Will scaring occur? No. The process is done entirely in your mouth, which means that there is no risk for any type of scarring on your face.
8.  Can kids and adults have DO performed? Yes, people of all ages can have DO performed. In general, the younger you are, the less time you will spend with the distraction tool in your mouth. This means that adults may experience a longer period of time that they must use the tool, they may also have a longer consolidation period.

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