If there is not enough bone present at a particular site in the mouth to sufficiently support a dental implant, then a bone grafting procedure will be needed. This will replace bone already lost by previous tooth removal, and allow implant placement to proceed.
Assessment of the quality, quantity and specific location of available bone is performed by visual and physical examination, dental radiographs x-rays), and study models of the teeth. If further information is needed, then a 3D image can be taken using a CBCT scan of the area.
There are different types of bone grafting procedures depending on the clinical situation:
- GUIDED BONE REGENERATION (GBR) – this technique uses artificial bone and membrane products to act as a template and aid bone formation in the required area. This is a quick and simple procedure that is usually performed at the same time as the implant surgery. It acts to provide support for the implant and can be used to alter the gum profile, and hence create a more aesthetic visible gum line.
- SINUS LIFT/BONE GRAFT – If there is insufficient bone present in the posterior region of your upper jaw, then it may be possible to create more bone volume using a sinus lift/bone graft procedure. A sinus is an air-filled cavity on either side of the nose that often limits the height of bone in the posterior areas of the upper jaw. The sinus can be accessed by a surgical procedure inside your mouth, and bone or bone substitute products added to make more room available for implants to be placed.
Why are bone grafts necessary?
For a dental implant to successfully placed and maintained there needs to be sufficient bone volume at the proposed implant site. If there Is not enough bone present, then the implant cannot osseointegrate to the bone and it will fail. Tooth loss leads to subsequent bone loss, and this rate of bone loss varies between patients depending on many factors. Also, the shape, size and position of each individual sinus can vary considerably, and often get larger as a person ages, meaning that a sinus lift/bone graft is necessary to create enough space and bone volume for implant placement.
How is bone volume evaluated?
Bone volume can be evaluated by physical examination, study model assessment and dental radiographs. In some cases a 3D CBCT scan image is required to provide more information of the proposed implant site. These CBCT scans are sent to a consultant radiologist to provide a detailed report of the entire scan contents. Reasons for a CBCT scan can include:
- If there is insufficient bone at the proposed implant site
- Where more detailed analysis is required to determine the exact bone height and width available.
- To indicate the precise location of particular anatomical structures such as nerves and sinuses.
- Prior to a sinus lift/bone graft procedure to determine the exact anatomy of this structure.
What are the different types of bone graft materials used?
The different types of bone grafts used at the Dutch Barton Practice include:
- AUTOGENOUS – bone taken from another site in the mouth of the patient.
- XENOGRAFT – bone products derived from animals specifically to be used for bone grafting procedures.
- ALLOPLASTS – synthetic bone substitute products.
The different options available for bone grafting procedures are thoroughly discussed with each patient prior to formulating a treatment plan. The Dutch Barton Dental Practice currently use products supplied by Geistlich and Botiss.