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When a Bone Graft Is Necessary
A bone graft is used to preserve or build up jawbone so that there’s enough bone to support dental implants. But what causes the loss of bone in the first place? There are many common reasons why there may not be enough bone in the jaw, such as:
- Gum disease
- Resorption of bone
- Congenitally missing teeth
- Structural difference between tooth and implant
- Tooth or jawbone trauma
The most common cause of tooth loss is gum disease. If you lost a tooth to gum disease, it’s likely that the disease caused the loss of bone around your natural tooth. If there’s not enough bone to support a tooth, then there’s not enough bone to support a dental implant.
Your body also begins to remove bone from your jaw as soon as your teeth are removed. If you had your teeth extracted and didn’t get dental implants placed right away, you have probably lost much of your jawbone. The longer you’ve worn dentures, the more bone you’ve lost.
Similarly, if you never developed a tooth or teeth in the area where the implants are placed, then your body may never have grown the necessary bone. A bone graft can be used to encourage the body to grow new bone.
Often, though, a graft is necessary just because of the structural difference between implants and natural teeth. Titanium implants are much stronger than your natural teeth, so they can be narrower. But because they’re narrow, the socket from the natural tooth doesn’t contact the implant. A bone graft bridges this gap.
If you lost a tooth or teeth to an accident, it’s likely that you lost jawbone with it. A bone graft can help replace this bone to support the dental implant.
Types of Bone Grafts
There are three common types of bone grafts used in dental implant procedures:
- Socket preservation graft
- Block graft
- Sinus augmentation
The most common type of bone graft is the socket preservation graft. This is used when dental implants are placed right after tooth extraction. As mentioned above, the tooth socket is usually too large for the implants, so we need a graft to fill the space between the implant and the bone. This type of graft is usually performed when the implants are placed.
A block graft is used when you are missing a lot of bone in a large area of the jaw, whether because of gum disease, trauma, resorption, or some other cause. In this type of graft, the bone blocks are typically taken from other parts of your jawbone, secured with screws, and allowed to heal for months before the dental implant is placed.
Sinus augmentation is used when there is concern that the dental implants will penetrate into the sinuses–air pockets connected to your nose and running throughout the bone under your face. The lining of the sinus is moved and the area underneath filled with bone graft material. This type of graft can be performed either at the same time as your implant procedure or months before.
Where Does the New Bone Come from?
Ultimately, the new bone will be produced by your body. Bone grafting materials are used only to provide a framework that can stand in until your body is able to produce new bone around the implant. But the initial bone graft material can be classified as either autograft or allograft.
An autograft is a bone graft that comes from you. It’s taken from someplace else in your body (usually other parts of the jawbone) and relocated to the surgical site. This is most often used in block graft procedures.
An allograft is bone material from other people or even animals (such as cows), then cleaned of all cellular material–it’s just bone mineral content–before is it used. This is most often used in socket preservation and sinus augmentation.
Are There Alternatives to Bone Grafting?
Yes. If your body doesn’t have enough bone to support implants in the primary treatment plan, we can often sidestep the need for bone grafting with several techniques:
- Mini implants
- Special implant placement
- Supportive bars or dentures
- Functional compromise
Depending on the nature of your treatment plan, we may be able to use mini implants instead of full ones to give you the results you desire. Because mini implants are smaller, they can fit where full implants could not, although more implants are usually needed.
Sometimes, we can get away with angled implants–including zygomatic implants–that maximize contact between implant and bone. Whether these are useful or not depends on the amount of bone you actually have and the locations of missing teeth.
Supportive bars or specially designed dentures can sometimes help you avoid a bone graft because they distribute the force more evenly in the mouth.
Finally, we may have to make functional compromises if you don’t want a bone graft. The easiest way to reduce demand on implants is to make dentures retained by implants, but supported by your gums.
Implant-supported dentures bear all the force of your bite and pass that force onto your jawbone. That gives your bite about the same strength as with natural teeth. Implant-retained dentures are held in place by your implants, but the force of biting mostly goes to your gums. This reduces the strength of your bite.
During your consultation, we will talk about these options and help you find the one that’s right for you.