Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee). Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that are placed under the gums to protect the bone graft and encourage bone regeneration. This is called guided bone or guided tissue regeneration.
For smaller defects, the bone is obtained from an outside artificial source. Synthetic materials are often used to stimulate bone formation. In some cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers or from a bovine source and used to promote the patients own bone to grow into the repair site. During the preparation of the graft, strict, aseptic sterilization techniques are employed and approved by the FDA to ensure that there are no transmissible agents in the grafts. The material is devoid of proteinaceous matter and only contains the minerals from the donors. It is very effective and very safe. Additionally, we can also use factors from your own blood to accelerate and promote bone formation in graft areas (see section on Platelet Rich Plasma). The latest advancements in tissue engineering technology has allowed the use of concentrated bone forming proteins (known as BMPs) to allow predictable and abundant bone regeneration. The technology comes at a high cost, therefore, is only reserved for complex and difficult clinical situations.
These procedures may be performed separately or together with implant placement, depending upon the individual’s overall condition of the native bone at the site. As stated earlier, there are several areas of the body that are suitable for obtaining bone grafts. In the facial 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 patients own bone for repairs, we generally get the best results. However, due to the morbidity of a second surgical site, this is reserved for larger defects.
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 patients 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.
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