After teeth are lost, the jawbone in the area begins to resorb or remodel. Over a period of time, this bone loss can become severe, leaving an insufficient amount of bone remaining to place dental implants. Through various bone grafting techniques, bone can be added to these deficient areas, thus regenerating the bone which had been lost. The two most common types of bone grafting procedures performed in the office are called the sinus lift and ridge augmentation.
Sinus Lift Procedure
The maxillary sinuses are air-filled cavities above your back teeth in the upper jaw. Following tooth loss and subsequent bone loss in that area, there is often insufficient bone height in the back of the upper jaw to place dental implants. This procedure involves elevating or "lifting" the lining of the sinus cavity and placing the bone graft onto the sinus floor. This essentially increases the amount of bone above the back of your upper jaw, allowing implants to now be placed.
Alveolar Ridge Augmentation
The alveolar ridge is the part of your jaw that holds the roots of your natural teeth. After tooth loss, the alveolar bone resorbs, leaving a defect in the ridge which must be corrected prior to implant placement. This procedure increases the height and/or width of the ridge by placing a bone graft under the gums in that area.
In cases where bone resorption is mild to moderate, it is often possible to perform the bone graft and place the dental implants simultaneously. However, in severe cases, the bone must be grafted prior to implant placement. Then, following a healing period of three to six months, the dental implants can be placed.
Bone Grafting Options
Bone Morphogenic Protein (rhBMP-2)
Growing your bone using advanced technology
When bone is lost due to missing teeth, disease or infection, then the area must be "rebuilt" to provide a solid foundation for dental implant placement. Advanced technology has introduced a product known as BMP, which has simplified bone grafting procedures and increased treatment results significantly.
Everybody has a protein called BMP (Bone Morphogenic Protein) and this messenger tells the body where to form new bone. Medtronic corporation makes a synthetic BMP (recombinant engineered human bone morphogenicprotein-2), marketed under the name INFUSE, which enables us to create bone by simply adding this protein in the site where new bone is desired. The advantages are many and include: simplifying the bone grafting surgery; reduces the need to borrow ("harvest") bone from elsewhere in the body; less discomfort; less complications and decreases the amount of surgery required which allows a faster recovery time.
In summary, the use of rhBMP is surgically placed where the new bone growth is needed and the material is secured under a membrane barrier. The growth factors then attracts your body's own building and healing cells to the surgical site and over time, new bone is formed and provides the foundation necessary for dental implant placement.
This is an excellent option in bone reconstruction treatment.
CT images above show a bone defect "hole", which is an inadequate foundation for appropriate implant placement.
Following a healed BMP bone graft, a CT "slice" view confirms that adequate bone is now present for implant placement.
Use of BMP graft corrected the bone defect and allowed for proper implant placement.
Bio-Oss® or Xenograft
Bio-Oss® is a natural, bone substitute product that is used to regenerate bone in areas of the jaw where bone is missing. It consists of the mineral portion of bovine bone. Bio-Oss® provides the body with a matrix for bone cell migration and is integrated into the natural remodeling process of the body. This product is used in many types of bone grafts, including "site preservation".
Allogeneic Bone is a special chemically and irradiated sterilized human bone grafting material. Procurement: All tissue meets stringent donor screening and laboratory testing to reduce the risk of transmitting infectious disease. Processing: The processing of all donor tissue consists of a strict, quality-controlled procedure that involves thorough cleaning and gentle dehydration of the bone with solvents. The process leaves no harmful residue and eliminates antigenic properties and has never been shown to cause disease transmission. Allografts are used in dental bone grafting procedures.
Platelet Rich Plasma (PRP)
Platelet Rich Plasma (PRP) is a preparation of blood (plasma) that is rich in platelets. New technology permits the doctor to harvest and produce a sufficient quantity of platelets from only 30 cc (or less) of blood drawn from the patient while they are having outpatient surgery.
PRP permits the body to take advantage of the normal healing pathways at a greatly accelerated rate.
What is so exciting about PRP? PRP permits the body to take advantage of the normal healing pathways at a greatly accelerated rate. During the healing process, the body rushes many cells to the wound in order to initiate the healing process. One of those cell types is platelets. Platelets perform many functions, including formation of a blood clot and release of growth factors (GF) into the wound. The more growth factors released into the wound, the more stem cells stimulated to produce new host tissue. PRP then permits the body to heal faster and much more efficiently.
PRP has many clinical applications
- Bone grafting for dental implants. This includes onlay grafts, sinus lift procedures, ridge augmentation procedures, and closure of cleft, lip and palate defects.
- Repair of bone defects creating by removal of teeth or small cysts.
PRP also has many advantages
- Safety: PRP is a preparation of the patient's own blood, therefore, disease transmission is not an issue.
- Convenience: PRP can be generated in the doctor's office while the patient is undergoing an outpatient surgical procedure, such as placement of dental implants.
- Faster healing: The saturation of the surgical wound with PRP, and thus growth factors, produces an increase of tissue synthesis and thus faster tissue regeneration.
- Cost effectiveness: Since PRP harvesting is done with only 60 cc (or less) of blood in the doctor's office, the patient need not incur the expense of the harvesting procedure in hospital or at the blood bank.
- Ease of use: PRP is easy to handle and actually improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.
Frequently asked questions about PRP
- Is PRP safe? Yes. During the outpatient surgical procedure a small amount of your own blood is drawn out via the IV. This blood is then placed in the PRP centrifuge machine and spun down. In less than fifteen minutes, the PRP is prepared and ready to use.
- Should PRP be used in all bone-grafting cases? Not always. In some cases, there is no need for PRP. However, in the majority of cases, application of PRP to the graft will increase the final amount of bone present in addition to making the wound heal faster and more efficiently.
- Will my insurance cover the costs? Not Usually. Occasionally, the cost of the PRP application is paid by the patient.
- Can PRP be used alone to stimulate bone formation? No. PRP must be mixed with either the patient's own bone, a bone substitute material such as demineralized freeze-dried bone, or a synthetic bone product.
- Are there any contraindications to PRP? Very few. Obviously, patients with bleeding disorders or hematologic diseases do not qualify for this in-office procedure. Check with Dr. Dorfman to determine if PRP is right for you.