Bone grafting can repair potential implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is obtained either from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee.) Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that ultimately dissolve under the gum tissue and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
Major bone grafts are typically performed to repair large defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are best 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 hip (iliac crest) and lateral knee (tibia) are common donor sites.
The maxillary sinuses are behind your cheeks and directly above your 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 adequate bone to hold them in place. When the sinus wall is very thin it is impossible to place dental implants in such 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 augmentation and implant placement can sometimes be performed as a single procedure. If enough bone is not available the Sinus Augmentation will have to be performed first and 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.
In severe cases where the ridge has been reabsorbed a bone graft can be placed to increase ridge heighth and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants.
In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.
As stated earlier, there are several areas of the body that are suitable for obtaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be obtained from the hip or the outer aspect of the tibia at the knee. When we use the patient’s own bone for repairs, we generally get the best results.
In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is obtained from human cadavers and used to promote the patient’s own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.
These surgeries are performed in the office surgical suite under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.
EXPOSURE OF AN IMPACTED TOOTH
An impacted tooth simply means that it is “stuck” and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections among a host of other problems (see “Wisdom Teeth” under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary cuspid (upper eye tooth) is the second most common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong biting teeth which have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.
Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tightly together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. 60% of these impacted eye teeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch.
Early recognition of impacted eye teeth is the key to successful treatment:
The older the patient the more likely an impacted eye tooth will not erupt by nature’s forces alone even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panorex screening x-ray along with a dental examination be performed on all dental patients at around 7 years of age to count the teeth and determine if there might be problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present or if some adult teeth are missing.
Are there extra teeth present or unusual growths that are blocking the eruption of the eye tooth?
Is there extreme crowding or too little space available causing an eruption problem with the eye tooth?
This exam is usually performed by you oral surgeon or general dentist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require a referral to an oral surgeon for extraction of over retained baby teeth and/or selected adult teeth that are blocking the eruption of the all important eye teeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age 11 or 12, there is a good chance that the impacted eye tooth will erupt with nature’s help alone.
If the eye tooth is allowed to develop too long (age 13-14), the impacted eye tooth will not erupt by itself even with the space cleared for its eruption. If the patient is too old (over 40), there is a much higher chance the tooth will be fused in position. In these cases the tooth will not budge despite all the efforts of the orthodontist and oral surgeon to erupt it into place. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).
The preparation of your mouth before the placement of a prosthesis is referred to as pre-prosthetic surgery.
Some patients require minor oral surgical procedures before receiving a partial or complete denture in order to ensure the maximum level of comfort. A denture sits on the bone ridge so it is very important that the bone is the proper shape and size. If a tooth needs to be extracted, the underlying bone might be left sharp and uneven. For the best fit of a denture, the bone might need to be smoothed out or reshaped. Occasionally, excess bone might need to be removed prior to denture insertion.
One or more of the following procedures might need to be performed in order to prepare your mouth for a denture:
bone smoothing and reshaping (Alveoplasty)
removal of excess bone (Torus Reduction)
bone ridge reduction
removal of excess gum tissue (Gingivectomy)
exposure of impacted teeth
We will review your particular needs with you during your appointment.
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth:
Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
· A sore that fails to heal and bleeds easily
· A lump or thickening on the skin lining the inside of the mouth
· Chronic sore throat or hoarseness
· Difficulty in chewing or swallowing
These changes can be detected on the lips, cheeks, palate and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology and is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.
We recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we may help.