A Complete Guide to Bone Grafting
I believe you will find my guide to dental bone graft to be comprehensive and informative.
In this guide, I will share with you my knowledge, experience, and treatment examples that relate to bone grafting.
My name is Dr. Rana Shahi, DDS, MS, MSD, and owner of LA Periodontics & Implant Specialists --- which is one of the leading periodontal centers in Los Angeles and Brentwood, California.
So if you're searching to learn as much as you can about a dental bone graft, I hope that you will my guide to be of value.
DR. RANA G. SHAHI, DDS, MS, MSD
Diplomate, American Board of Periodontology
What Is A Dental Bone Graft?
A bone graft is a surgical procedure performed to strengthen weak, damaged, or diseased bone in the body. Using bone from elsewhere in the body or a cadaver, a surgeon will remove a piece of healthy bone and transplant it where there has been bone loss or the bone is weak or damaged.
Although we typically think of our bones as hard and solid, a lot is going on inside of our bones that allows for a grafting procedure to be effective. Inside our bones are living cells that work to heal our bones when they break. When you transplant a piece of healthy bone to an unhealthy bone, the cells in the healthy bone will work to heal the unhealthy one. There are sometimes cases where the bone does not graft. We talk about that later in Chapter 7.
Bone grafting is used for many purposes, such as fractures that are not healing on their own, bones affected by cancer or osteonecrosis, and knee replacements.
Dental Bone Grafts and Dental Implants
Dental bone grafts are performed for regenerative purposes to help restore bone loss in the jaw. A bone graft may also be used for preventative measures. If you have periodontal disease that has started to cause bone loss, you might need a bone graft to prevent further bone loss and keep your teeth in place.
The reason for most dental bone grafts is in preparation for dental implants. Dental implants are used when a patient is missing teeth or has had teeth removed. Implants replace the tooth root with a metal post and replace the teeth with functional, artificial teeth. For dental implants to be successful, your jawbone needs to be strong enough to provide a firm foundation to support the new teeth.
Unfortunately, patients who need dental implants often have weak jaws. This is because tooth loss can lead to something called resorption, which is when the bone shrinks because it is not being used to hold a tooth in place, and no stress is being placed with chewing. Aging and dentures can also cause resorption
Fortunately, dental bone grafting can correct this. By performing a bone graft on the jaw before dental implant surgery, a periodontist can ensure that a patient has a strong enough base to support the implants. A patient will usually have to wait a certain amount of time after a bone graft before getting implants, because the graft needs time to create new, strong, healthy bone.
Today, it is not uncommon for a periodontist to perform a bone graft during a tooth extraction surgery in case the patient decides to get implants in the future.
While a dental bone graft might sound like a big, scary surgery, periodontists perform them routinely, so there is no need to worry; it is a standard procedure with a high success rate. However, recovery time is needed, which we talk about in detail in Chapter 5.
Dental Bone Graft Types
Dental bone grafts are not one-size-fits-all. There are several different types of dental bone graft procedures and types of material. We will cover both in this chapter.
Dental Bone Graft Materials
A periodontist can use a few different types of material for a dental bone graft: bone from the patient’s body, bone from another species, or manufactured bone.
An autograft transfers bone or tissue from a location in the patient’s body to the grafting site. This bone can be taken from inside the mouth or elsewhere in the body, such as the hip bone, tibia, or rib. Autografts are the gold standard for dental bone grafts because bone from a patient’s body is living tissue, meaning the cells are intact, so the graft is more likely to be successful. Autografts also heal more quickly than other types of grafts
An autograft requires two surgeries, which means more recovery time and a higher chance of infection or post-operative problems. Still, these grafts are the most reliable and, therefore, the most common.
An allograft transfers bone or tissue from a living donor or cadaver to the patient. Some patients prefer this procedure to the autograft to avoid undergoing two surgeries. However, allografts take longer to incorporate into the patient’s bone and do not have as high a success rate as autografts. They are a good option for patients who have limited time to be in surgery and recovery.
A xenograft uses bone or tissue from another species, usually a cow, because their bone make-up is similar to a human’s. Xenografts can also be taken from other animals, such as pigs and horses.
Using bone between species may sound like a strange option, but xenografts are useful when larger amounts of graft material are needed, because you can extract more tissue and bone from these animals than from humans. Xenografts are also completely safe. Tissue and bone taken from animals and used for xenografts go through a strenuous purification process in order to be prepared for human use.
An alloplast graft is a synthetic bone graft, meaning it does not use human or animal bone, but instead, a material known as alloplast. Alloplast is made up mostly of tricalcium phosphate and hydroxyapatite, which are calcium phosphates found in natural bone. An alloplast is a good option for someone who does not have sufficient bone or tissue for an autograft. The material is exceptionally sturdy and highly compatible with bone.
Bone Graft Procedures
The location of the proposed bone graft will determine the type of procedure your periodontist will perform. Popular types of bone grafting include:
This type of bone graft occurs directly after a tooth extraction procedure. Your periodontist will extract your tooth and then fill the empty tooth socket with the bone graft material.
This is a similar procedure to preservation, but is performed on patients who have previously lost a tooth, resulting in bone loss.
If your upper jawbone has receded, your periodontist may perform a sinus lift where she/he lifts the sinus membrane and puts the grafting material between it and the upper jaw.
A nerve called the inferior alveolar nerve, which gives feeling to the chin and bottom lip, can sometimes get in the way of dental implants in the lower jaw. A periodontist can reposition this nerve and fill the existing pockets with grafting material.
Allograft Bone Ring Procedure
As mentioned in Chapter 1, patients need time to heal after a bone graft procedure, before they can undergo dental implant surgery. Healing time varies due to the patient’s health, bone deficiency, and surgery required. Patients with large bone defects often need what is called a bone block procedure. A bone block procedure harvests a small block of bone from the patient’s jaw and places it into the affected area, securing it with titanium screws. Most patients require four to six months to heal after a bone block procedure, prior to getting their implants.
Because of recent grafting technology, however, patients in need of a bone block no longer have to wait the four to six-month recovery period. In fact, they no longer need two separate procedures, due to the Allograft Bone Ring.
An allograft bone ring is a piece of cylindrical material made of human donor bone. These rings can be used in place of the autografted bone block. As soon as the ring is in place, a periodontist can perform the dental implant procedure.
This is revolutionary in the area of periodontology. What once required two surgical procedures with four to six months of healing time in between, now only requires one procedure. In addition, the patient does not have to endure two surgery sites, since an allograft bone ring is harvested from human donor bone rather than their own bone.
While allograft bone rings have been in use in Europe for several years, they only became available in the U.S. in 2017. Because of this, few periodontists are familiar with the complex procedure.
The experts at LA Periodontics and Implant Specialists are proud to offer this type of cutting-edge care to patients. Using the renowned Straumann® AlloGraft Bone Ring technique, we have been able to cut down on patients’ chair, surgery, and recovery time.
The Straumann® AlloGraft Bone Ring is made of processed allogenic donor bone. Its porous structure allows for the bone ring to quickly and naturally integrate with the existing jawbone.
Most patients want to avoid having multiple dental surgeries over the course of several months to a year. Thanks to the allograft bone ring, this waiting time no longer has to be an obstacle to a patient in need of dental implants. A patient can come in for one procedure and walk out with a brand new tooth.
While the autograft has been considered the “gold standard” of gum grafts for several decades, the allograft bone ring and its availability in the U.S. may be changing this standard, especially among patients with severe bone damage and loss.