Is a Bone Graft Necessary? Ask the Implantologist.
It is possible for the insufficient bone volume of the patient to present a stumbling block to implant treatment. A solid structure is necessary for the implant screw to withstand the daily pressure of oral function.
There are a variety of reasons why a patient may not have enough bone structure to handle a dental implant and thus will need a bone graft to be able to achieve the desired outcome. These may include:
CT Scans and the Initial Consultation are Key to Answering this Question.
Initial consultations are necessary in order to establish a correct diagnosis and formulate an appropriate treatment plan for each patient.
As part of your consultation, our Implantologists will examine your mouth and surrounding areas, review your medical history, and discuss your expectations. We use CT scans to determine if enough bone is present to place the implants, or if a bone graft is needed. The main difference between regular x-rays, such as panoramic x-rays, and CT scans is that typical x-rays are presented in 2D and thus cannot determine bone volume.
CT scans, on the other hand, produce tridimensional images, allowing for a comprehensive assessment of bone structure. As part of this process, vital structures in the surrounding area and pathological areas are analysed.
Simply put, an Implantologist can’t determine whether or not a patient needs a bone graft or whether they are suitable for dental implants without a CT scan.
Different Bone Grafting Techniques to Support Specific Needs
When a patient’s bone structure is not sufficient for dental implants, there are several bone grafting techniques that can be used to restore the bone’s condition, allowing the Implantologist to place the implant.
Different techniques are employed based on the type of bone defect, the amount of bone to be restored, and the location of the bone defect.
During the initial consultation, the Implantologist will discuss with you your bone condition in the area where implants will be placed and, if a bone graft is needed, what is involved and how it will be performed.
Techniques used for bone grafting
For decades, researchers have documented and tested this technique for regenerating bone using a bone graft material – usually Bio-Oss, which is placed in the area of the bone defect where our implants will be placed. A collagen membrane is used to cover the bone graft material, usually Bio-Gide from Geistlich.
In addition to holding the bone graft in place, it will also encourage new bone formation by guiding the patient’s own bone cells to the grafted area.
After the bone graft material has been in place for a while, it will change from a particulate to rock-solid consistency, then eventually be absorbed by the patient’s own bone.
Though each patient’s situation is unique, severe bone resorption can occur if an upper molar is missing or has been extracted. In such cases, our experienced clinicians can correct the problem with a sinus lift procedure.
A sinus lift, also referred to as a maxillary sinus floor augmentation, increases the volume of the upper jaw bone. When there is not enough bone near the maxillary sinus to support the placement of implants, Dr. Santos will recommend this procedure.
The implantologist may decide on block grafting when the patient lacks sufficient bone structure to place implants. In this case, it is likely the jawbone would be moved from the lower jawbone.
Two small screws will be used to secure the graft, which will be overlaid with collagen membrane and xenographic materials. To ensure the implant area is ready for placement, there is usually a waiting period of 4-6 months.
These days, these techniques are rarely used since there are less invasive alternatives that provide a more successful long-term outcome.
The procedure of socket preservation involves placing graft material or scaffold in the socket of an extracted tooth in order to preserve the alveolar ridge.
In some cases, jaw bones need to be preserved after extraction in order to preserve the shape of the sockets. When the sockets are not preserved, the bone is susceptible to resorption.
It may be necessary to increase bone volume around the maxillary sinus depending on the individual case.
There are two applications of this technique:
- The preparation and establishment of the implant site, which previously lacked sufficient bone structure for a successful placement,
- then; a procedure to increase the bone density of the treatment area.
It’s possible to categorise bone defects as horizontal or vertical. If the bone is missing in height, it’s called a vertical defect, and if it is missing in width, it’s called a horizontal defect.
Combined defects, in which there is both a height and a width missing, can happen and are the most challenging to repair.
In a horizontal defect, bone grafting may be performed simultaneously with implant placement if the implant can be stabilised by enough bone. It may be necessary to perform a bone graft before implant placement if otherwise.
For vertical bone defects, the first step is usually a bone graft. When the bone has matured, the implants can be inserted.
As for a combined defect, the stages would be similar.
MIC uses Geistlich BioMaterials in bone grafting procedures
Our practice uses Geistlich biomaterials for 95% of its bone grafting procedures. They are market leaders in regenerative dentistry.
In our bone grafting treatments, we primarily use Bio-Oss and Bio-Gide. The combination of Bio Oss and Bio Gide results in long-term implant survival and positive aesthetic outcomes for Marylebone Implant Centre patients.
For more information about biomaterials and bone grafting, please contact our team!
Is my own bone used for the bone graft?
The Marylebone Implant Centre rarely harvests bone from patients.
A patient’s own bone (autogenous) was the gold standard material in bone grafting procedures in the past.
These bone grafts tend to heal very quickly since they have the same genetic code as the recipient site. Patients’ ribs or skulls have traditionally been used as sources of bone for surgery.
Bone harvested from the chin or ramus of the jawbone has become more popular in recent years.
In the last decade, block graft techniques have almost become obsolete because of issues related to these methods, like extensive bone resorption (bone shrinkage).
Therefore, bone harvested from the patient is very effective in the early stages, though it can cause problems with the implants in the long term.
In addition to the poor stability over time, using autogenous bone also requires a second surgical site, which causes unnecessary discomfort for patients.
Do you perform the bone graft before placing the implant?
Implantologists are usually able to place implants and perform bone grafting simultaneously.
When these procedures are performed concurrently, there is not only a reduction in overall treatment time, but also a greater degree of control for the Implantologist in terms of biomaterial placement.
Simultaneous procedures are commonly performed when between 10-40% of the horizontal bone is missing. Each case needs to be evaluated individually, and during the consultation, patients will have the Implantologist explain the recommended treatment sequence to them.