Dental Bone Grafting: The First Step in Rebuilding your Smile

What is bone grafting?

Bone grafting is the process of rebuilding bone where deterioration has occurred. Through the implantation of the donor’s bone into the jaw, Dr. Romanow and Dr. Wentworth encourage the body to grow new bone on its own. This procedure is typically done to prepare the jaw for a dental implant but can be performed for other structural needs as well.

Jaw Health

Your teeth do more than just chew and bite. They keep your jawbone “in shape” by providing regular stimulation. Without that stimulation, the alveolar bone (the part of the jaw that anchors teeth) dissolves as the body reallocates minerals elsewhere. This process happens relatively fast when you lose a permanent tooth, a common cause of jawbone loss. Other causes include periodontal disease, dentures, trauma, tumors, and more. 

With jawbone loss, patients face:

  • Problems with remaining teeth
  • A collapsed facial profile
  • Skin wrinkling
  • TMJ pain including headaches
  • Speech and nutrition problems.

Luckily, there is a fix:

Minor Bone Grafting

There are a variety of types of bone grafting – most of which are considered “minor bone grafting” and are typically done by Drs. Romanow and Wentworth in preparation for a dental implant. Dental implants require that there is adequate bone in the jaw. Often, there is not, and that is where bone grafting comes in – to build up bone in preparation for an implant.

Major Bone Grafting

When a significant amount of bone loss has occurred due to trauma, cysts, tumors, or a defect, major bone grafting is often required. This advanced process often requires additional materials and technologies and sometimes several specialists.

Jawbone loss can result from various factors:

  1. Periodontal Disease: Bacteria buildup leads to bone and tooth loss.
  2. Tooth Extractions: Missing teeth cause jawbone loss; bone grafting can restore support for dental implants.
  3. Tumors and Cysts: Growth may require partial jaw removal and major bone grafting for rehabilitation.
  4. Facial Trauma: Fractures and tooth loss contribute to bone deterioration.
  5. Dentures: Unanchored dentures lead to inadequate jaw stimulation and bone loss; implant-supported dentures offer a solution.
  6. Bridges: Lack of stimulation under prosthetic teeth causes bone loss.
  7. Misaligned Teeth: Over-eruption due to lack of opposing teeth results in bone loss.
  8. Developmental Deformities: Birth conditions affect jaw development.
  9. Sinus Deficiencies: Removal of upper molars leads to sinus-related bone loss.
  10. Infection (Osteomyelitis): Bacterial infection causes inflammation and bone loss.

Where does the new bone come from?

The bone used in grafting can come from a variety of places: your chin, hip, leg, and skull are all common donor sites. In addition to that, bone-grafting materials are sometimes used from bovine (cow) sources, as well as human cadavers. There are pros and cons to each, which will be discussed with you as we determine the best course of action.

Bone grafting materials are diverse, including natural and synthetic options:

  1. Autografts: Your own bone from sites like the chin, jaw, hip, or skull, containing living elements to promote bone growth. Requires an additional harvesting procedure.

  2. Allografts: Human cadaver bone provides structural support and encourages bone growth, eliminating the need for a second procedure.

  3. Xenogenic Bone: Donated from non-living animals like cows, processed to encourage acceptance by the body, functioning similarly to allografts.

  4. Synthetic Materials: Various substitutes available, eliminating the need for a second procedure.

  5. Bone Morphogenetic Proteins (BMPs): Naturally occurring proteins in the body that promote healing and bone formation.

  6. Demineralized Bone Matrix (DBM): Growth factor-rich collagen matrix from allograft bone, enhancing bone growth.

  7. Composite Grafting Materials: Combines various substances like collagen, ceramic, growth factors, and bone for optimal grafting.

These materials offer tailored options for patients’ needs.

Types of Bone Grafting

Some of the most common types of bone grafting include:

Sinus Lift – The maxillary sinuses are air-filled spaces above the upper jawbone. A loss of bone in this area requires a special bone-grafting procedure called a “sinus lift” to rebuild the bone in preparation for a dental implant. Also known as “sinus augmentation”, this common procedure is done by raising the sinus membrane and placing bone-grafting material underneath it. This procedure has revolutionized care for those with no upper teeth who would like a more comfortable and convenient option than dentures can provide.

Socket Preservation – When a tooth is extracted, it leaves behind an empty socket. Because there is no tooth to stimulate the jawbone, the socket may expand as the jawbone resorbs due to lack of use. Socket preservation is a preventative measure that is performed by implanting bone grafting material at the same time as extraction to preserve the jawbone for future tooth replacement.

Ridge Augmentation – Ridge augmentation is similar to socket preservation in that it involves the repair of the bone underneath an empty tooth socket. However, instead of being done at the same time as extraction (as with socket preservation), it is performed after bone resorption has already occurred. The treatment involves the implanting of bone grafting material in the site to act as scaffolding for new bone growth.

Nerve Repositioning – Nerve repositioning is the process of moving the inferior alveolar nerve to make room for dental implants in the lower jaw. During the procedure, the nerve is moved out of the way for implant installation and then replaced. The pockets are then filled with bone grafting material to bulk up the jawbone. Because this nerve is responsible for feeling in the lower lip and chin, there is often postoperative numbness, which can sometimes be permanent. For this reason, it is considered to be an aggressive treatment choice and requires very careful consideration.

What is bone grafting recovery like?

You will be adequately anesthetized during the procedure. However, as with any dental surgery, you may experience some soreness as the anesthesia wears off. Typically, our patients can control the pain with over-the-counter medications, and any necessary prescriptions will be discussed at your appointment before the procedure. After the procedure, the bone is left alone to heal and grow for three to six months before implants can be placed.