If we think about the jaw bone in terms of the rest of our skeleton, the gradual loss of bone from the site of a missing tooth makes sense. As we all age, we are increasingly aware of the effects of osteoporosis. One of the best ways to prevent osteoporosis is to participate in frequent weight-bearing exercise. The forces exerted on our skeleton during exercise prevent the loss of bone quality and quantity. The jaws are no exception. When teeth are present, the forces of chewing can certainly be considered weight-bearing exercise for our jaws. After the loss of a tooth, the bone in that particular area is no longer being exercised, and it begins to shrink. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. This is also why placing implants at the time of tooth removal is advisable when possible. Once a healed implant is placed into function (tooth is attached), it transmits forces to the bone just as did the natural tooth root, and the forces of chewing continue to maintain the bone around an implant as it does around the teeth.
Today, even when a tooth has been missing for an extended period of time, our patients can still be implant candidates. In some cases, we are able to utilize our technology (such as our iCAT cone-beam CT) or other advanced techniques to avoid the need for grafting altogether.
In the event that a site does not have the available bone to make dental implants a viable option, bone grafting is likely an option. Bone grafting is a process of growing (or recreating) bone where it has been lost. At ArkLaTex Oral & Maxillofacial Surgery, we have products and techniques at our disposal which allow you to achieve the maximum benefit with minimal cost and discomfort. Historically, bone grafting was performed by taking bone from one location of your body and moving it to your jaw. Currently, the need for a second surgical site has been made largely unnecessary by newer techniques using allografts and bone substitutes.
Historically, hearing the words “bone grafting” would likely have patients looking for the exits. Today, materials and techniques are available that make this procedure simple and cost-effective, with a much shorter recovery period than expected.
Sinus LiftThe maxillary sinuses are behind your cheeks and above the roots of the upper teeth. Sinuses are like empty rooms that have nothing in them. Over our lives, the sinuses enlarge and begin to scallop around the tooth roots of the upper molars. Depending on age and anatomy, some of the roots of the natural upper teeth will extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place, so when the sinus wall is very thin, it is impossible to place implants without a sinus lift procedure.
To perform a sinus lift, Dr. Smith, Lustig, Banker, or Johnson enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and bone (usually from a donor) is placed into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patients jaw and dental implants can be inserted and stabilized in this new sinus bone.
Often patients are concerned that shrinking the sinus will cause sinus problems. Though a sinus lift does shrink the sinus slightly, performing a sinus lift typically returns the enlarged sinus back closer to its original size.
The availability of sinus grafting makes it possible for many edentulous patients to have dental implants when years ago there was no other option other than wearing loose dentures. Even better still, we have techniques available (such as a fixed hybrid denture) that may allow the placement of implants in these patients without the need for sinus grafting.
In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.
For your comfort, various anesthetic options are available, including local anesthesia (numbing medicine), oral sedation, and/or intravenous sedation.