Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
Today, we have the ability to grow bone where needed. 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.
When you need to have a tooth or teeth extracted—whether it be due to decay, abscess, gum disease or injury—it is usually in your best interest to do so in a manner which preserves as much of your underlying jawbone as possible. From the time the teeth are removed, significant degeneration of the surrounding bone begins to take place. You have many options to prevent this, and it is important that you consider them BEFORE any teeth are removed. Some of these procedures are best performed at the time the tooth is removed. Dr. Gumplinger is a surgeon who has additional years of training in procedures like tooth removal, jawbone preservation and dental implant placement.
There is a special type of bone surrounding your teeth. This bone is called alveolar “ridge” bone, and exists solely to support your teeth. As soon as the tooth is removed, this bone begins to degenerate and “melt away.” This occurs in two dimensions. The first is loss of horizontal width caused by the collapse of the bone surrounding the socket. This makes the remaining ridge narrower than when the tooth was present. The second is a loss of vertical height. This makes the remaining bone less “tall.” This melting process is faster in areas where you wear a partial or complete denture.
You will have several choices of how you can replace the newly missing teeth. All of the options rely on bone support and bone contour for the best function and esthetics. Here is a list of the possible options:
Other replacement alternatives include removable partial or full dentures. These often perform better with more supporting bone.
There are two important phases in retaining your alveolar ridge during and after the tooth extraction. Not all extractions are the same—Dr. Gumplinger will use the most careful techniques to extract the teeth while preserving as much bone as possible. Second—and key to preventing the collapse of the socket—is the addition of bone replacement material to the extraction socket.
There are several types of bone grafting materials and techniques—Dr. Gumplinger will discuss the most appropriate one with you. After the tooth is extracted, the socket will be packed with a bone-like material and covered with a membrane and suture. Early on, the grafting material will support the tissue surrounding the socket, and in time will be replaced by new alveolar bone. This bone will be an excellent support should you choose later to have dental implant-supported replacement teeth.
Although the bone created by socket grafting supports and preserves the socket, it will not do so indefinitely. Placing dental implants five to twelve months after the extraction and socket grafting will provide the best long-lasting support for preserving your jawbone and allow you to function as before. Otherwise the graft may “melt away” or resorb over time.
In some selected cases it is possible to actually extract the tooth and place the dental implant at the same time. We call that immediate implantation. If you are interested in replacing your tooth with an implant and want to be considered for immediate implantation, please call Dr. Gumplinger’s office for a consultation prior to your extraction.
All patients receive the most careful bone-preserving extraction techniques at no additional charge. There is an additional charge for performing a socket grafting procedure at the time of the extraction. Charges vary depending on the tooth location and number of teeth. At the time you call Dr. Gumplinger’s office for your appointment, you should state that you are interested in jawbone preservation when your tooth is removed. A cost estimate will be provided at the time of your consultation visit after you had a chance to thoroughly discuss your procedure with Dr. Gumplinger.
The maxillary sinuses are behind your cheeks and on top of the 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 bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this 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 augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation will have to be performed first, then 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 tooth supporting ridge has been reabsorbed a bone graft is placed to increase the ridge width. In these situations, the graft is taken from a tissue bank or another area inside your mouth and transplanted into the deficient area. Once transplanted, it will grow in its new location. This in-office procedure takes about an hour.
Bone grafting can also repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. In addition, special membranes may be utilized that dissolve under the gum 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 defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are 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 skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.