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Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
Today, we have the ability to place and 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 functionality and aesthetic appearance.
For a patient who needs a tooth removed, and who wants eventually to have a dental implant placed, a socket preservation bone graft can be placed into the extraction site at the time of extraction. This bone is procured from a donor and ground into fine particles. It is usually covered with a collagen sponge and secured with stitches. The socket preservation graft slows down the loss of bone resulting from extraction, and makes it possible to place an implant after adequate healing time.
The loss of teeth almost always results in loss of the bone that was supporting the teeth. If the loss of bone is great enough, the placement of dental implants might not be possible. In this situation, your surgeon will have to perform a grafting procedure to restore adequate volume of bone so that the implant will be completely covered with bone. Ideally, this bone for grafting will come from within your own jaw. Other times, in situations where a large amount of bone is required, the bone will need to be taken from your hip or your tibia. Most of the procedures are carried out in the office, but there are patients who require hospitalization. In all cases, the graft is allowed to heal for many months prior to implant placement.
Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.
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 dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted 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 patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.
The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.
If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.