Jaw Repair for Dental Implants

If you lose a tooth, you will need adequate dental bone if you wish to replace the missing tooth with a dental implant. Below is the process to replace a missing tooth with an implant for a patient with sufficient dental bone.

Regular Dental Implant Process (if no bone grafting is needed):

• Visit 1: Implant placement
• Wait 2-6 months
• Visit to Dentist: Ready for the cap/crown on the tooth (prothesis)

Over a period of time, the jaw bone associated with missing teeth atrophies or is reabsorbed. 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 placement of dental implants.

If you have experience jaw bone loss, you will need a bone graft procedure to prepare for dental implants. Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and aesthetic appearance.

For more information about Bone Grafting or to schedule a consult with Dr. Foretich, please use our Appointment Request form or call our office in McLean, VA at McLean Office Phone Number 703-867-9499.

Minor Bone Grafting

Minor bone grafting can repair parts of your jaw bone with inadequate bone structure due to previous extractions, gum disease, or injuries. The bone is either obtained from a tissue bank (donated, safe, off-the-shelf bone) or taken from your own jaws. In addition, special membranes/protective covers may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration.

Procedure:

• Visit 1: Bone graft procedure to re-establish previous shape and size of jaw bone
• Wait 4–6 months
• Visit 2: Implant placement
• Wait 2-6 months
• Visit to Dentist: Ready for the cap/crown on the tooth (prothesis)

The various minor bone graft procedures are explained below:

Socket Preservation

Very often, after removal of a tooth, a small amount of bone is placed in the space left by the tooth. This procedure, called Socket Preservation, is painless and ensures adequate height and width of bone for future implant placement (roughly 3–4 months after tooth removal). Adding this bone graft takes only an additional 10 minutes once a tooth is removed.

Procedure:

• Visit 1: Tooth removal & socket preservation bone graft
• Wait 4 months
• Visit 2: Implant placement
• Wait 2–6 months
• Visit to Dentist: Ready for the cap/crown on the tooth (prothesis)

Sinus Lift Procedure

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.

There is a solution and it's called a sinus graft, or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient's jaw and dental implants can be inserted and stabilized in this new sinus bone.

The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.

If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.

Single Visit Sinus Lift Procedure (if it's minor and done at the same time as implant placement):

• Visit 1: Sinus Lift Bone Graft & simultaneous Implant placement in upper jaw bone
• Wait 6 months
• Visit to Dentist: Ready for the cap/crown on the tooth (prothesis)

Two-Visit Sinus Lift Procedure (two-stage sinus lift bone graft):

• Visit 1: Sinus Lift Bone Graft
• Wait 4–6 months
• Visit 2: Implant placement in upper jaw bone
• Wait 6 months
• Visit to Dentist: Ready for the cap/crown on the tooth (prothesis)

Major Bone Grafting

Major bone grafts are typically performed to repair defects of the jaws. 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 surgeries are performed in the out-office surgical suite (operating room) under IV sedation or general anesthesia and therefore require a hospital stay. After discharge, bed rest is recommended for one day and limited physical activity for one week.

Ridge Expansion

In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase jaw bone ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.

Nerve Repositioning

The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants in the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and second premolar, with the above-mentioned secondary condition. Because this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever), usually other, less aggressive options are considered first (placement of blade implants, etc.).

Typically, an outer section of the cheek side of the lower jaw bone is removed to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area and slightly pull it out to the side. At the same time, we will place the implants. Then the bundle is released and placed back over the implants. The surgical access is refilled with bone graft material of the surgeon's choice and the area is closed. These procedures may be performed separately or together, depending upon the individual's condition.

Bone Graft Materials

As stated earlier, there are several areas of the body that are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region, or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. When we use the patient's own bone for repairs, we generally get the best results.

In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to promote the patients own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.