Bone Grafting / Jaw Reconstruction
Dental implants have become an excellent clinical alternative to replace missing teeth with dentures of bridges. In the past, missing teeth could only be replaced with full or partial dentures, bridges, or other removable prostheses. Since many patients experience the loss of bone with loss of teeth, bone grafting is often performed as part of the implant treatment process to provide sufficient bone for the implants to be placed. Bone Grafting is the replacement or augmentation of the bone around the teeth. It is performed to reverse the bone loss/destruction caused by periodontal disease, trauma, infection, or ill-fitting removable dentures. Bone Grafting is commonly used to rebuild bone in the sinus area prior to implant placement or to enhance esthetics of a missing tooth in the smile zone. There are a number of methods for augmenting existing bone that Dr. Krakowiak will review with you during your visit.
Why Bone Grafting?
Over a period of time, the jawbone associated with non-preserved extraction site or long term missing teeth can experience significant bone loss as it naturally is reabsorbed. Bone Grafting, a simple but very effective surgical technique can prevent or greatly reduce the amount of bone loss that generally occurs after a tooth is extracted. Loss of bone after tooth extraction can hamper the surgeon’s ability to adequately place an implant. In most cases, if the extraction socket is immediately filled with graft material, new bone will be generated with virtually no loss or alveolar bone height or width. Not grafting the site 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 would not be candidates for placement of dental implants. We fortunatley now 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 esthetic appearance.
Dr. Krakowiak is very experienced in provision of full range of autogenous bone grafting (from the patient’s own stock of bone) to optimize the body’s healing. Other options available are to use bone mineral from other sources such as animal bone mineral or cadaveric human bone mineral. We are also able to use advanced bone replacement procedures using BMP-2 growth factors and PRP growth enhancers. These more contemporary techniques often minimize the need to harvest and use the patient’s own bone and hence result in less discomfort and faster healing in our patients.
What Happens After My Bone Graft?
Bone grafting aftercare is generally handled like aftercare of most dental surgical procedures. The graft site should be kept free and clear of food and debris. Dr. Krakowiak can help prescribe a gentle antibiotic mouth rinse to keep the area clean. Dr. Krakowiak may also prescribe systemic antibiotics and/or an oral analgesic to help avoid infection or any mild discomfort you may experience. You must avoid applying any pressure to gum tissue around the graft site until the healing process is significantly completed. Once the site is completely healed, Dr. Krakowiak re-evalaute the site and he will work with you and your general dentist to start the implant placement process.
Type of Advanced Bone Graft Procedures
The site of a freshly extractred tooth can receive graft after teh extraction to stabilizethedimensions of the residual ridge an prevent teh standard loss of bone that will otherwise ensue after tooth is removed.
Sinus lift procedure
This procedure involves elevating the sinus membrane and placing the bone graft materials onto the sinus floor, allowing implants to be placed in the back part of the upper jaw.
In severe cases the ridge has been reabsorbed and a bone graft is placed to increase the ridge height and/or width.
In some cases the existing bone can be grown by strectching it slowly after application of a distraction appliance making a few scoring cuts in the bone itself.
Although not a true graft procedure this procedure has a net effect same as a graft. It give us more room to place implants in cases of the resorbed posterior mandible. In these cases the inferior alveolar nerve, which gives feeling to the lower lip and chin, may be surgically moved out of the implant site in order to make room for placement of dental implants to the lower jaw.
RH-BMP( Recombinant Human Bone Morphogenic Proteins)
INFUSE® Bone Graft contains a manufactured bone graft material that is FDA-approved for use in certain oral surgery procedures, including sinus augmentation and localized alveolar ridge augmentation.
INFUSE® Bone Graft consists of two main components: a manufactured version of a protein that’s normally found in the body and a natural carrier for delivery of the protein. The protein is rhBMP-2 (recombinant human bone morphogenetic protein 2) in a pure, freeze-dried powder form. This is a naturally occurring protein common to all humans and animals with bone that is found in very small amounts, and its purpose is to stimulate bone formation at the site in which it’s placed.
The natural carrier is an absorbable collagen sponge (ACS), which is made from a material found in bone and tendons. The ACS releases the protein over time in the location where it is placed, and provides a scaffold on which new bone can grow. As the graft site heals, the ACS is absorbed and replaced by bone.
One of the primary advantages of INFUSE® Bone Graft is that it is an alternative to autograft – the use of autogenous bone (from the hip, rib, leg, jaw or chin) for implantation into a void or defect elsewhere in the body, such as the bones of the jaw. Prior to INFUSE® Bone Graft, autogeneous bone traditionally provided patients with the best grafting results in oral surgeries such as a sinus augmentation. INFUSE® Bone Graft eliminates the need for the bone-harvest surgery that autograft requires, an additional procedure that, depending on the location, may be painful for some patients and lengthen the overall healing process.
Our practice has extensive experience with this revolutionary method of rebuilding bone. Dr. Krakowiak has lectured as well as published his work in this area in the national level.
PRP( Platelet Rich Plasma)
PRP therapy accelerates healing of oral and facial soft tissues. PRP is an emerging treatment in a new health sector known as ”Orthobiologics.” The philosophy is to merge cutting edge technology with the body’s natural ability to heal itself. Blood is made of RBC (Red Blood Cells), WBC (White Blood Cells), Plasma, and Platelets. When in their resting state, platelets look like sea sponges and when activated form branches. Platelets were initially known to be responsible for blood clotting. In the last 20 years we have learned that when activated in the body, platelets release healing proteins called growth factors.
There are many growth factors with varying responsibilities, however cumulatively they accelerate tissue and wound healing. Therefore after increasing the baseline concentration of these platelets, we are able to deliver a powerful cocktail of growth factors that can dramatically enhance tissue recovery. The treatment option uses bodies own constituents at concentrated levels to optimize the rate of soft tissue healing and growth.
PRP has been used for over 20 years ago in the oral surgery to enhance wound healing in cancer patients with jaw reconstruction. Soon afterwards its applications extended across many fields of medicine from cardiovascular surgery to orthopedics. Multiple studies are underway to help further refine the treatment and demonstrate its efficacy.
These procedures may be performed separately or together, depending upon the individual’s condition. There are several areas of the body, which 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.
These surgeries are performed in the office under I.V. sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.