About Bone Grafting
What is Bone Grafting?
Over a period of time, the jaw bone associated with missing teeth atrophies and is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for the placement of dental implants. In these situations, most patients would not be good candidates for the placement of dental implants without rebuilding the bone.
With bone grafting we now have the opportunity to not only replace bone where it is missing, but we also have the ability to promote new bone growth in that location. 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 esthetic appearance. We know from experience that placing implants in sites without proper bone support can result in bone loss and implant failure.
MAJOR BONE GRAFTING
Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease, or injuries. We use a technology which combines use of your own regenerative cells (PRGF) along with a bone product. The bone products are carefully prepared human, animal or combination products. In some cases we can utilize your own bone most typically getting it from a local source like the jaw. In some major surgeries such as facial reconstructive surgery we will use bone grafts from the hip or tibia (below the knee). Sinus bone grafts are also performed to replace bone in the back part of the upper jaw. In addition, special membranes may be utilized that dissolve under the gum to protect the bone graft, as well as encourage bone regeneration. This is called guided bone regeneration, or guided tissue regeneration.
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. Most all of our grafting is now done with prepared bank bone or synthetic bone substitutes along with the PRGF technology.
Types of Bone Grafts
Autogenous Bone Grafts
Autogenous bone grafts, also known as autografts, are made from your own bone, taken from somewhere else in the body. The bone is typically harvested from the chin, jaw, lower leg bone, hip, or the skull. Autogenous bone grafts are advantageous in that the graft material is your own live bone, meaning it contains living cellular elements that enhances bone growth, also eliminating the risk of your body rejecting the graft material since it comes from you.
However, one downside to the autograft is that it requires a second procedure to harvest bone from elsewhere in the body. Depending on your condition, a second procedure may not be recommended.
Allogenic bone, or allograft, is dead bone harvested from a cadaver, then processed using a freeze-dry method to extract the water via a vacuum. Unlike autogenous bone, allogenic bone cannot produce new bone on it’s own. Rather, it serves as a framework, or scaffold, over which bone from the surrounding bony walls can grow to fill the defect or void.
Xenogenic bone is derived from non-living bone of another species, usually a cow. The bone is processed at very high temperatures to avoid the potential for immune rejection and contamination. Like allogenic grafts, xenogenic grafts serve as a framework for bone from the surrounding area to grow and fill the void.
Both allogenic and xenogenic bone grafting have an advantage of not requiring a second procedure to harvest your own bone, as with autografts. However, because these options lack autograft’s bone-forming properties, bone regeneration may take longer than with autografts, and have a less predictable outcome.
Bone Graft Substitutes
As a substitute to using real bone many synthetic materials are available as safe and proven alternatives, including:
Demineralized Bone Matrix (DBM)/Demineralized Freeze-Dried Bone Allograft (DFDBA)
This product is processed allograft bone, containing collagen, proteins, and growth factors that are extracted from the allograft bone. It is available in the form of powder, putty, chips, or as a gel that can be injected through a syringe.
Graft composites consist of other bone graft materials and growth factors to achieve the benefits of a variety of substances. Some combinations may include: collagen/ceramic composite, which closely resembles the composition of natural bone, DBM combined with bone marrow cells, which aid in the growth of new bone, or a collagen/ceramic/autograft composite.
Bone Morphogenetic Proteins
Bone morphogenetic proteins (BMPs) are proteins naturally produced in the body that promote and regulate bone formation and healing.
Synthetic materials also have the advantage of not requiring a second procedure to harvest bone, reducing risk and pain. Each bone grafting option has its own risks and benefits. Dr. Wagner will determine which type of bone graft material best suited to your particular needs.