Bone Grafting

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Learn About Bone Grafting in Kingston

What is a bone graft?

Bone grafts are used to fortify areas where the natural bone is compromised or incapable structurally to support a dental restoration. Common causes of structurally compromised bone include periodontal disease or loss of teeth.

If our oral and maxillofacial surgeon determines that the site of a planned implant requires additional bone mass he may recommend a bone graft either prior to or in conjunction with the implant placement. Bone grafts may use autologous (the patient's own) bone or an alloplastic or allogeneic bone substitute.

Oral and maxillofacial surgeons commonly use bone grafting techniques as part of facial reconstructive and orthognathic surgical procedures (corrective jaw surgery), often harvesting a slice of bone from the patient's hip, rib or skull to aid in filling large gaps in the mandibular or maxillary jawbones.

1-Ridge Augmentation(Tooth Socket Preservation)

A localized alveolar ridge augmentation after tooth extraction, or "ridge augmentation," involves placing bone graft directly into the empty socket where a tooth's roots used to be, to help create the natural shape of the gums and jaw that may have been lost following tooth extraction. Patients may need a ridge augmentation procedure after losing one or more teeth, to prepare for future dental restoration.

Rebuilding bone in the alveolar ridge-
The localized alveolar ridge of the jaw is the bone that surrounds the roots of the teeth. When a tooth is removed, it leaves behind an empty socket in the localized alveolar ridge bone. Usually, the socket will heal on its own, filling in with bone and tissue. Sometimes the walls of the socket are thin and break during tooth removal, or they were missing before the procedure. When the bony wall on the side facing the cheek is missing, it's called a "buccal wall defect." These types of sockets typically do not heal to their previous height and width, and bone loss continues because there's no tooth to retain the bone.

If a patient wants to replace a lost tooth with a dental implant or lost tissue has caused an aesthetic problem, then the localized alveolar ridge must be reconstructed. A Bone graft can help promote bone growth. After a tooth extraction, it can help preserve the height and width of the localized alveolar ridge (socket site preservation).

Ridge augmentation surgery- 
A ridge augmentation procedure is performed by placing graft material into the tooth socket. This can often be performed immediately after the tooth has been removed. The gum tissue is then placed back over the socket and sutured. Once the socket area has healed, the previous surgical site can be prepared for a dental implant.

Dental implants are designed to serve as the anchor for artificial teeth (crowns) that look, feel, and function like natural teeth. Dental implants typically are very small, screw-type posts placed into the jawbone where teeth are missing. The bone bonds(integrates) with the post, creating a strong foundation for artificial teeth. Dental implants help preserve facial anatomy and also help prevent the bone deterioration that usually occurs when teeth are missing.

A ridge preservation procedure typically can be performed in our office under local anesthesia or sedation.

After Ridge Augmentation Surgery
Every implant case is unique. The entire process, from tooth extraction to final dental implant placement, may take up to a year.

Dr. Matthew Hilmi will have a specific recovery plan for you to follow after your procedure. To maximize a successful outcome, you must carefully follow your recovery plan.

Potential Risks and Complications
As with any surgery, surgical treatment to promote bone growth in the jaw is not without risk. A variety of complications related to surgery or the use of bone graft may occur. Some of these may be severe and affect the outcome of your case. Additional surgery also may be required to correct complications.

Potential Complications Include:

*Allergic reaction to the implant materials
*Bone formation that is not normal, in excess or in an unintended location
*Damage to nearby tissues or nerves
*Pain or discomfort
*Scar formation or other problems with the surgical incision
*(Short-term) mild to severe swelling
*Side effects from anesthesia or the surgical approach
*Skin swelling or irritation

Sinus Augmentation(Sinus Lift Surgery)

Loss of posterior teeth may result in excessive forces being placed on your remaining teeth. Fortunately, the use of dental implants and crowns allow you to replace these missing teeth. However, the position of the sinus in the upper posterior areas may be too low for proper placement of dental implants.

A simple procedure allows the sinus floor to be repositioned, creating enough space to properly place an implant. Various grafting materials are used to encourage your bone to grow more quickly into the area, helping to stabilize the dental implant. Replace with your own bone in this area the grafting material as it grows into the area.
Under certain conditions, an even simpler procedure can be utilized. When possible, the bone remaining under the sinus floor is gently “pushed up”, thus lifting the floor of the “dropped” sinus. Bone replacement materials are then placed beneath this lifted bone. Once again the bone materials are replaced as your body grow new bone into this area.

Sinus augmentation procedures are highly predictable, with studies reporting over 95% success. Following sufficient healing of a sinus augmentation (6-10 months), implants are placed in a predictable and successful manner. It is important to realize that if the sinus augmentation procedure does not result in enough bone for implant placement, additional bone may be regenerated through

3-Nerve Repositioning:

While it is always preferable to save natural teeth if possible, sometimes the best option available is to extract a tooth and opt for a dental implant at some point in the future. This means that you should educate yourself about some of the preparations that must be done when looking at dental implant surgery. Some of these, like nerve repositioning, can seem like daunting procedures – but at Mid-Hudson Oral and Maxillofacial Practice, PC, we understand how to best approach the procedure in order to effect an excellent outcome. What is nerve repositioning? When navigating the dental implant process, it is important to recognize that sometimes the inferior alveolar nerve – the nerve that provides feeling to your chin and lower lip – might need to be moved in order to create adequate room for implant placement. This is a relatively advanced option, however, there are some patients that are simply excellent candidates for the procedure.

If you are a candidate and our surgeon believes this surgical option is likely to be a success, then we will reposition this particular nerve so that it sits further away from the implant in question before we actually place the implant. What is the nerve repositioning process like? We generally remove a section of the gingiva (gum tissue) on the side of your lower jawbone. This will expose the vessel and nerve canal. Once we successfully isolate the nerve, we very gently pull it out to the side. When we place the dental implants, we will also track the neurovascular bundle in order to ensure that it does not get buried or misplaced. When the implants have been placed, the bundle is then placed back into position and everything is sutured closed. The area where we accessed the nerve will also be filled with of bone graft material prior to closure. Why would the nerve need to be repositioned?When teeth are extracted and no socket preservation is done, it is very common for the tissue and bone that used to hold the missing tooth in place to decrease in size. This can leave the nerve a little too close to the surface when undergoing dental implant surgery. That is why our surgeon must sometimes move the inferior alveolar nerve in order to successfully place dental implants without causing chronic pain and/or numbness.

Mid-Hudson Oral

And Maxillofacial Practice, PC Dr. Matthew Hilmi

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