Bone Grafting - prior to implants or bridge work

When the extraction of teeth is necessary, it is possible to preserve the majority of bone volume to facilitate implant placement, particularly when the tooth fractures or decay is above the gum line

However, sometimes it is necessary to build up the bone in an area where you have had a tooth removed/extracted and are proposing to have either an implant or bridge placed.

In circumstances where infections and or fractures exist below the gum line then bone and gum resorption/recession is a possible outcome of tooth extraction

 

The procedure

This can be achieved by three ways:

1) Using a plastic sheet under the gum. This sheet makes a space for the bone that you lost after having your tooth out. Your own bone will eventually grow into this space. Sometimes your own bone (from another area) is required to fill the space under the plastic sheet. Your Periodontist will let you know if this is necessary.

2) A combination of a bone graft (cow bone product name Bio-Oss®) and a collagen sheet (pig collagen product name Biogide®) can be placed into the site. This can stimulate your own bone to grow into this area. Sometimes your own bone (from another area) is mixed with the bone graft. Your Periodontist will let you know if this is necessary.

3) A block of bone is sometimes indicated in some patients. This is taken from your jaw bone and secured to the area of bone deficiency. A sheet of collagen or plastic is then used to cover the block graft.

 

Grafting procedures

The deficient area can be grafted with bone blocks or the use of a membrane (plastic or collagen sheet) that is wrapped over the bone defect. This is left to heal for 3-6 months

Implants can the be placed into the healed site and allowed to heal for 6-8 weeks.

These procedures can be done in the chair with local anaesthetic, IV sedation or a general anaesthetic (Day surgery). Most patients have these procedures done under local anaesthetic or IV Sedation. Procedure 3 is usually done under IV sedation or General Anaesthetic.

A 4-6 month healing period is required prior to implant placement. If having a bridge treatment can commence 1-2 months after the surgery is carried out.

Chair time depends on the type of procedure, but usually ranges between 45 minutes to 2 hours.

Following the healing of the implant a post and crown can be placed onto the implant, giving a natural appearance.

 

Post-operative considerations

After surgery, it is important not to clean the surgical area for about 7-10 days or until the sutures have been removed.

You can expect some swelling and bruising to occur after these types of procedures. These post-operative occurrences are part of the healing process.

Using a mouthwash containing Chlorhexidene (i.e. Savacol, plaquacide, available from chemists), is all that is needed for keeping the area clean during this period.

After this initial period of healing, gentle brushing with a soft toothbrush can be resumed.

It is important not to place pressure in these areas while eating and if wearing a denture it is important to leave it out for as long as possible during he first couple of weeks

 

Benefits of treatment

The placement of bone in sites which are deficient allows for better implant placement. This can ultimately lead to better implant position and more bone around the entire surface of the implant which allows for better attachment to bone and longevity and aesthetic outcomes.