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BONE GRAFT

In the past, patients with low jaw bone volume had prostheses or dental bridges as their only options. Currently, this disadvantage no longer exists. Find out how bone graft rebuilds the jaw for dental implant insertion.

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BONE LOSS CAUSES

Some of us do not have enough healthy bone volume to support implant work. This bone failure can have multiple causes, such as:

  • Certain periodontal diseases
  • The teeth grew in a bad way
  • Dentures have been used for many years
  • An accident or a blow injured the jaw bone
  • The empty space left after the extraction of one or more teeth
  • Other dental interventions suffered in the past and which did not aim at restoring the natural bone.

The procedure specific to implantology that restores the amount of bone needed for implants is called bone addition or bone addition.

BONE GRAFT TECHNIQUES

To reconstruct the bone, to regain the natural features of the jaw and to be able to perform the dental implant operation, several bone addition techniques are used. Some of these can be applied immediately, so you can benefit from your natural smile on the same day. Others require repeated interventions that last for long periods of time of the order of several months.

To better understand what it is about, we present a classic case of edentulousness (missing tooth) with resorption and the reason why a dental bone addition is necessary.

Dental edentation

1. The patient has only one tooth. As you can see, all the other teeth have whole and healthy roots, well anchored in the mandibular bone.

Bone resorbed due to lack of stimuli

2. Immediately after the tooth falls out, the bone begins to resorb in that area due to the lack of stimulus.What kept it before it fell was its root.

Accentuate bone resorption

3. The more time passes, the more the mandibular bone is resorbed. If many years have passed, the implant can no longer be inserted directly because now the bone level is low.

Improperly placed implant

4. If we placed the dental implant directly in the bone, it would be below the line of the other teeth which would make chewing difficult. In addition, it would not look too good aesthetically.

Unstable implant

5. If we placed the implant at the level of the other teeth, the metal root would be extremely visible. Not only is it unsightly, but also unstable, because the implant is screwed too little.

Crown without base

6. Suppose we give up the implant and use a bridge or dental crown. This case is not optimal either because they will not have a fixing base and there will be a gap between them and the bone.

Reconstruction with bone addition

7. The only solution for lifting and reconstructing resorbed bone is bone addition. With the help of an instrument, the doctor fills the gap with a dental bone substitute.

Graft cover

8. After the substitute (dental bone graft) completely fills the gap, the implant surgeon isolates the addition work with the help of another dental instrument.

Closing bone surgery

9. The end of the bone addition operation consists in sewing the area with sutures. The patient is sent home and the healing process begins. After a while the bone graft will be absorbed and fully integrated in the jaw.

Dental implant insertion

10. After the absorption is over and the area is healed, the dental implant can be inserted. It will look and behave like a natural tooth, because the bone that supports it has been rebuilt.

SOURCES OF BONE SUBSTITUTES

Augmentation or addition of a dental bone is a safe procedure that, when performed by an experienced implant surgeon, has a very high degree of success. The operation involves the reconstruction of bone tissue by adding bone grafts that are harvested from any of the following sources:

  • Autologous graft (Autograft) - bone taken from your own body. It is usually obtained from below the knee, hip or even from the jaw by making a small incision and collecting a few milligrams of bone tissue.
  • Transplant from a donor (Allograft) - bone obtained from another person (organ bank). It has a lower integration and adaptation rate than the autologous graft, which automatically involves higher costs.
  • Artificial graft (Alloplasty) - synthetic bone powder, manufactured in the laboratory. These artificial materials are processed and tested in the laboratories of internationally certified manufacturers.
  • Animal graft (Xenogrefa) - obtained by deproteinization and processing of bone of animal origin (bovine).

THE SURGERY

In order to perform the bone addition procedure and then insert the implants, it is necessary to first establish in which bone parameters the jaw is (hardness, thickness and height of the bone). This can be found in the preoperative consultation, based on a panoramic radiograph or a computed tomography.

OPERATION STAGES

1. The operation begins with a usual anesthesia, as in the case of any dental treatment and continues with the extraction of the affected tooth (if applicable).

2. The next step is to access the target site by separating the tooth gum and disinfecting the alveolar cavity (the area where the initial tooth was). After the root is cleaned and disinfected, it is augmented with a bone graft.

3. At the end, insulate the work with a specific material and apply a few stitches.

WAITING DATE UNTIL THE IMPLANT INSERTION

Sometimes, when the patient's clinical situation is not aggravated, bone addition can be performed under anesthesia during the insertion of the dental implant.

Sometimes, the waiting time or duration between the addition of bone and the dental implant is quite long (at least 3 months) and this is because, as I said, the bone substitute must osseointegrate (to connect with the natural bone).

However, it should not be exaggerated in terms of duration. Thus, if it is too short, osseointegration will not be done properly. Conversely, if we are too late, the newly created bone will resorb.

PARTICULAR CASES

So far we have only talked about the classic case of augmentation with dental bone. But there are also particular situations that require bone addition and which we will discuss below.

SINUS LIFT AND ADDITION

One of these cases is the lack of molar and premolar teeth (masses) located on the upper arch. When these teeth fall out, the sinus cavity enlarges at the same time as the damage to the maxillary bone. Thus, the surgeon is forced to resort, in addition to bone addition, to another special procedure, called sinus lift.

INCREASING THE MAXILLARY CREST

Another particular situation is when the jaw bone is not wide enough for implants to be inserted. The procedure that solves this case is called Increasing the Maxillary Crest.

As in the classic bone addition, the bone graft can be added in a small proportion on the edge of the narrow jaw to enlarge it. Sometimes, the dental implant can be inserted immediately after the increase of the jaw crest, other times it takes long periods of time (4-12 months) for healing and osseointegration to be achieved.

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Dr. Chirurg Lorelei Nassar
Implantology surgeon

LORELEI NASSAR

Specialist surgeon with over 28 years of experience and over 10,000 dental implant operations in clinics in the USA, Sweden, UK, Israel and Romania.

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