What Is Bone Grafting?
Overtime, loss of teeth cause the jaw bone to atrophy. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for dental implants.
With bone grafting, we now have the opportunity to not only replace missing bone, but also the ability to promote new bone growth in that location. This gives us the opportunity to place implants of proper length and width. Additionally, we now have the chance to restore functionality and aesthetic appearance.
The bone is typically obtained from a tissue bank or another part of your jaw. Sinus bone grafting may also be performed to rebuild the vertical height of the bone in the posterior upper jaw. In addition, special membranes that dissolve under the gum in order to protect the bone graft and encourage bone regeneration may be utilized. This is called guided bone regeneration or guided tissue regeneration.
Major bone grafts are typically performed to repair defects of the jaw. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia) are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.
Types of Bone Grafting
Ridge Augmentation/ Expansion
A ridge augmentation is a common dental procedure often performed following a tooth extraction to help recreate the natural contour of the gums and jaw. The natural contour may have been lost due to bone loss as a result of a tooth extraction or for another reason.
The alveolar ridge of the jaw is the bone that surrounds the roots of teeth. When a tooth is removed, an empty socket is left in the alveolar ridge bone. Usually, this empty socket will heal on its own, filling with bone and tissue. Sometimes, when a tooth is removed, the bone surrounding the socket breaks, and it is unable to heal on its own. The previous height and width of the socket will continue to deteriorate.
Rebuilding the original height and width of the alveolar ridge is not medically necessary, but may be required for dental implant placement or for aesthetic purposes. Dental implants require bone to support their structure, and a ridge augmentation can help rebuild this bone to accommodate the implant.
Autogenous Bone Grafts
Autogenous bone grafts, also known as autografts, are made from your own bone taken from somewhere else in the body. The bone is typically harvested from the chin, jaw, lower leg bone, hip, or skull. Autogenous bone grafts are advantageous in that the graft material is live bone, meaning it contains living cellular elements that enhance bone growth.
However, one downside to the autograft is that it requires a second procedure to harvest bone from elsewhere in the body. Depending on your condition, a second procedure may not be in your best interest.
Allogenic bone, or allograft, is dead bone harvested from a cadaver and processed using a freeze-dry method to extract the water via a vacuum. Unlike autogenous bone, allogeneic bone cannot produce new bone on its own. Rather, it serves as a framework or scaffold over which bone from the surrounding bony walls can grow to fill the defect or void.
Xenogenic bone is derived from non-living bone of another species, usually a cow. The bone is processed at very high temperatures to avoid the potential for immune rejection and contamination. Like allogeneic grafts, xenogenic grafts serve as a framework for bone from the surrounding area to grow and fill the void.
Both allogeneic and xenogeneic bone grafting are advantageous in that they do not require a second procedure to harvest your own bone as with autografts. However, because these options lack autograft’s bone-forming properties, bone regeneration may take longer than with autografts and have a less predictable outcome.
How Do You Prepare For Bone Grafting?
Prior to any surgical procedure, a consultation with Dr. Jamali is a necessary. During the consultation, Dr. Jamali reviews the procedure and prepares you for the particular surgery. If you are having IV sedation, do not eat or drink 8 hours prior to your treatment. You have to be accompanied by an adult to take you home. Avoid taking medications that thins out the blood at least 10 days prior to surgery. Some of these are NSAIDs and herbal medications. Additionally, fish oil can cause bleeding. You have to be in optimal health and any medical conditions, such as diabetes or HTN, has to be well controlled.
Why Is A Bone Graft Performed?
The goal of our office is to give you an implant that lasts many decades. Implant requires proper soft and hard (bone) tissue. Bone grafting is performed in the areas where there are not enough bone.
What Can You Expect During A Bone Graft?
It really matters where in the mouth the bone grafting is done and the size of the defect. Duration for this procedure ranges anywhere from 30 minutes to 2 hours. During this period, you may choose to be awake or have sedation. Either way, Dr. Jamali assures that the procedure remains painless.
What Is The Followup And Recovery Like For A Bone Graft?
You should expect to have some swelling. The worst of it appears on the 4-5th day and then subsides. Only a small percentage of patients experience moderate pain. This can be easily controlled with adding other medications to the one prescribed by Dr. Jamali. Almost always sutures (stitches) are placed to keep the wound closed to facilitate the healing process. However, even with these placed, the patient has to remain on a liquid diet for the first few days and soft diet for 2 weeks after. Sutures are removed 2-3 weeks after the surgery. Smoking and consumption of alcohol is prohibited for at least 2 weeks after the bone graft.
What Are The Potential Costs?
The cost for bone grafting ranges from $950 – $5,500.
What Are The Potential Risks?
The main concern with bone grafting is failure. The chance of failure is low when a specialist does the procedure.
Bone Grafting Substitutes
Demineralized Bone Matrix (DBM)/Demineralized Freeze-Dried Bone Allograft (DFDBA)
This product is processed allograft bone, containing collagen, proteins, and growth factors that are extracted from the allograft bone. It is available in the form of powder, putty, chips, or as a gel that can be injected through a syringe.
Graft composites consist of other bone graft materials and growth factors to achieve the benefits of a variety of substances. Some combinations may include: collagen/ceramic composite, which closely resembles the composition of natural bone, DBM combined with bone marrow cells, which aid in the growth of new bone, or a collagen/ceramic/autograft composite.
Bone Morphogenetic Proteins
Bone morphogenetic proteins (BMPs) are proteins naturally produced in the body that promote and regulate bone formation and healing.
Synthetic materials also have the advantage of not requiring a second procedure to harvest bone, reducing risk and pain. Each bone grafting option has its own risks and benefits. Dr. Jamali will determine which type of bone graft material is right for you.