Dr. Kenneth Klonsky
Oral Surgery/Implants/Periodontist

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 major factors that affect jaw bone volume:

  • Periodontal Disease – Periodontal disease can affect and permanently damage the jaw bone that supports the teeth. Affected areas progressively worsen until the teeth become unstable.
  • Tooth Extraction – Studies have shown that patients who have experienced a tooth extraction subsequently lose 40-60% of the bone surrounding the extraction site during the following years. Loss of bone results in what is called a “bone defect”.
  • Injuries and Infections – Dental injuries and other physical injuries resulting from a blow to the jaw can cause the bone to recede. Infections can also cause the jaw bone to recede in a similar way.

 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.  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 – Human bone can be obtained from a bone bank (cadaver bone).
  • Synthetic (man made) - can be created in the laboratory and used in the bone grafting procedure.
  • Xenograft – This is the implantation of bovine (cow) 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 jawbone to be effective.  If the jawbone lacks 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 – Defects in the bone can occur due to injury, tooth loss or most commonly, moderate to severe periodontal disease.  The bone graft is used to fill in the ridge and restore the jawbone to its original size and shape.

What does bone grafting treatment involve?

Bone grafting is a fairly simple procedure which may be performed under local anesthetic; however if large amounts of bone area need to be grafted, general anesthetic may be required.

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 between the gum and 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 –  As research evolves we are learning more and more about how the body builds bone and teeth and the proteins involved in this process.  Tissue stimulating proteins may help to create lost support in areas affected by periodontal defects.

The gum is sutured in place and a follow up appointment will need to be made within 10 days to assess progress.  Bone grafting can be a highly successful treatment and a good base for future implant supported restorations.

If you have any questions about bone grafting, please ask Dr. Klonsky.

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