Services
Bone Grafting
The Need:
Over a period of time, the jawbone 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, many patients require adjunctive bone grafting prior to or simultaneously with the placement of dental implants.
Today, we have the ability to graft and/or 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.
Techniques:
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 dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
Bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of tooth loss, traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using either the patient’s own bone or purchasing a product - bone morphogenetic protein (BMP).
When using your own bone, bone is harvested from a number of different sites depending on the size of the defect. The jaw bone, hip (iliac crest), and lateral knee (tibia) are common donor sites. These procedures are routinely performed in our outpatient surgical suite, or occasionally in the hospital, if your health status requires it.
About Bone Grafting
What is Bone Grafting?
Over a period of time, the jawbone associated with missing teeth atrophies 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, many patients are not candidates for placement of dental implants.
With bone grafting, we now have the opportunity to not only replace bone where it is missing, but also the ability to promote new bone growth in that location! 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.
Types of Bone Grafts
Bone Grafting Overview
For a brief narrated overview of the bone grafting process, please click the image below. It will launch our flash educational MiniModule in a separate window that may answer some of your questions about bone grafting.
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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 (tibia), hip, or the skull. Autogenous bone grafts are advantageous in that the graft material is live bone, meaning it contains living cellular elements that enhance bone growth. It is considered the “Gold Standard” of bone graft materials, because it’s success rate is unmatched by other materials, and provides living bone adjacent to dental implants.
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. Fortunately today, a recombinant DNA product, BMP (bone morphogenic protein) can be used to grow your own bone, with your own DNA. This BMP gives the best of both worlds – your own bone, with often no donor site.
Bone Morphogenic Protein (BMP)
Recently, the FDA has approved the use of a protein called “Bone Morphogenic Protein” to actually grow bone where there is none. The product has been patented, and is sold by the company Medtronic, under the name “Infuse”. This is truly a remarkable material.
Basically, through recombinant DNA technology, they have manufactured the exact BMP molecule which exists in our bodies. BMP works by signaling stem cells to migrate to the area, converts them into osteoblasts, which are bone forming cells. These osteoblasts then basically grow bone in the area where the BMP was placed. This often eliminates the need for a donor site such as your hip or jawbone.
The material comes in a liquid form, which we spray onto a sponge type material. This “collagen sponge” soaked with BMP is then placed where bone is needed, such as in a sinus lift site, an extraction site, or on a deficient dental ridge where implants are to be placed. We also use it as an interpostional bone graft in orthognathic surgery. In 6 months, your body literally grows bone into the area, and implants can be placed. What is remarkable about this newly formed bone is the fact that you grow your own bone, with your own DNA makeup, and identical to other bone in your body on a molecular and microscopic level. It is very healthy bone, with a great blood supply, and is ideal to place implants into to support teeth.
Dr. Loestscher has extensive training and experience with the use of BMP, and has taught courses and lectured on its science and use as well.
Allogenic Bone:
Allogenic bone, or allograft, is dead bone harvested from a cadaver, then processed using a freeze-dry method to extract the water via a vacuum. Unlike autogenous bone, allogenic 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:
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 allogenic grafts, xenogenic grafts serve as a framework for bone from the surrounding area to grow and fill the void.
Both allogenic and xenogenic 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 the transfer of living cells to form bone, bone regeneration is minimal, and may take longer than with autografts, with a less predictable outcome.
Each bone grafting option has its own risks and benefits. Dr. Loetscher will determine which type of bone graft material is right for you.