Bone Grafting

Over a period of time, the jawbone associated with missing teeth atrophies or deteriorates. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants.  (see What happens if I don’t have dental implants?)

Today, periodontists have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore chewing function and esthetic appearance.

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries.  The bone is either obtained from a tissue bank or your own bone is taken from the jaw.

Below is a photograph of a tooth which was extracted and not replaced with a dental implant. The dashed, blue line indicates the deficiency in bone just one year after the tooth was removed and the dashed, black line indicates the volume of tissue that should be present (left picture). This site required bone grafting so that an implant could be placed in the proper position and an ideal cosmetic result achieved (right picture).

Photograph of Deficiency	Photograph After Bone Grafting

In many cases the bone loss is less severe and a dental implant can be placed at the same time as grafting.  In other cases the bone can be widened at the time of implant placement by a series of specially designed surgical instruments.

If you are missing a tooth, teeth, or all of your teeth and feel like dental implants may be right for you, we would be happy to evaluate the site(s) and determine the best treatment option for you.

These procedures are routinely performed in our office under IV conscious sedation.

Sinus lift procedure

The maxillary sinuses are behind your cheeks and on top of the upper teeth.  Sinuses are like empty rooms that have nothing in them.  Some of the roots of the natural upper teeth 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.  When the sinus wall is very thin, it is impossible to place dental implants in this bone.

There is a solution and it’s called a sinus graft or sinus lift graft.  The periodontist enters the sinus from where the upper teeth used to be and grafts bone to provide a suitable implant site.  After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new bone.  In the majority of cases, enough bone exists between the upper jaw ridge and bottom of the sinus to allow the implant and sinus grafting procedure to be done at the same time (also called an Osteotome Sinus Elevation).

X-ray before implant was placed. Dashed, blue line shows the current level of the sinus bone which was too thin for implant placement.	Successful implant placement with simultaneous sinus graft. Dash blue line shows new level of sinus.

In some cases, not enough bone exists to allow your periodontist to place the implant(s) and graft the sinus at the same time.  In this situation, the sinus graft (also called a Conventional Sinus Elevation) is performed first, and the implants are placed later.

Below are x-rays of a patient who had to have her bridge removed because the front tooth anchoring it fractured (x-ray on left). She did not want to have a partial plate that she would have to take out at night, and chose to have dental implants to replace the missing teeth. As you can see from the dotted lines on the left x-ray (which outline the sinus cavity), the sinus bone was thin and she needed a sinus graft before the implants could be placed. After the sinus graft was completed, implants were placed and she was happy to have individual permanent crowns on dental implants.

X-ray with dashed blue line showing thin sinus bone.	X-ray after sinus lift procedure showing regeneration of sinus bone	X-ray after the dental implants were placed in grafted sinus bone which are now ready for a permanent bridge.

The sinus graft makes it possible for many patients to have dental implants when years ago there was no option other than wearing loose dentures.