When teeth are lost, the bone and gums around them begin to diminish rapidly. Successful and long lasting implants require sufficient bone and healthy soft tissues/gums at the dental implant placement site. Bone volume can be affected by various factors but especially periodontitis, acute infections and the length of time after the loss of teeth are most critical.
The longer you wait before implant placement the more bone volume shrinks – especially in the aesthetic anterior region the inherent loss of gums can be irreversible.
As the needs of each person are different so each dental case/situation can be different. A critical and careful evaluation of the hard and soft tissues at missing teeth sites is essential for successful implant prosthetics.
Bone and soft tissue grafting techniques basically encourage the growth of bone and soft tissue where they have been lost. Bone grafting provides an optimum foundation for your dental implants and is essential in cases where aesthetics are most important.
REGENERATE WHAT HAS BEEN LOST
There are many grafting methods and materials to achieve a natural and long lasting result.
The idea behind any bone graft or transferred soft tissue graft is that it is eventually replaced by your own tissue to help support the foundations for your new teeth.
Soft tissue grafting is basically practised to optimize your gums around dental implant crowns. We want to see gum tissue (keratinized soft tissue that is naturally found on your palate and around your natural teeth) around your implants. Soft tissue grafts, either free gingival grafts or connective tissue grafts, are harvested from your tuberosity or palate. There are also various materials available that help to regenerate stable perimplant soft tissues.
Dental implant bone grafting is mainly used:
- to create new bone volume in defecient bone sites before or simultaneous with implant placement
- as a socket preservation immediately after extraction in order to prevent further bone loss
- to graft around implants in order to fill gaps or smaller defeciencies
There exist various types of bone grafting materials:
- Autogenous bone: bone harvested from other intraoral areas like the tuberosity, minimally invasive near the implantation site, the chin or in severe cases out of practice from the hip bone
- Xenografts: bone substitute processed from other species (bovine, …) most evidence based and most often used in our practice. For further information see also the most popular brand Bio Oss http://www.geistlich-na.com/en-us/
- Barrier membranes (often xenografts) are used to guide the generation of new bone and allow maturation of new bone by blocking out other faster growing cells from the regeneration site (epithelial and connective tissue cells)
- Alloplastic or synthetic bone graft materials: various materials with different resorbing times are successfully used here – normally some type of calcium phosphate
- Autotooth bone: grafting material processed out of your extracted teeth– very promising but we wait for more long term evidence – soon to come in our practice
- Allografts: bone substitute material processed out of the human species – various types eg demineralized freeze dried bone
Most often used types of bone grafting techniques in our practice:
- GBR (Guided Bone Regeneration) / Barrier Membrane Technique
- (see above: xenograft barrier membranes ), various kinds of membranes exist – most are resorbable like for example collagen membranes like BioOss or have to be removed at a later date
- Block bone grafts: (see also above: autogenous bone) are only done in cases of severe atrophy of the jaw bone – not only bone blocks are transferred here, various mixed techniques exist
- Sinus lift: The most often done bone augmentation in our practice for patients who wish for fixed teeth solutions and have not sufficient natural bone left in the posterior region of the upper jaw. The maxillary sinus (a paranasal sinus) is situated right above your upper molar teeth and if there is not sufficient bone left below the sinus an implantation is not possible without sinus augmentation. There are basically two different approaches (depending on the height of your natural bone left subantral (below) the sinus): the lateral (from the side of the sinus) and the percrestal or internal sinus lift where access is done over the implant site.
For full arch missing teeth, graftless dental implant solutions are available:
- Allon 4 dental implants (see all on 4)
- All on 6 dental implants: the same as all on 4 but with one additonal implant in the pterygoid region of the upper jaw