In order for a dental implant to be successful the patient must have sufficient bone in the jaw to place the implant into. Usually the quality and quantity of bone in the jaw is reflective of how the bone healed after the tooth was removed, and not an underlying medical condition.
It was once assumed that if a patient did not have enough bone in their jaw they would not be suitable for dental implants. Today, thanks to the massive advances in dental techniques and technology patients with insufficient bone in the jaw can have the bone rebuilt using bone grafting.
Bone grafting procedure
The actual bone grafting procedure is much more straightforward than you might think. Bone grafting will only take place after your dentist has assessed the quality and quantity of the bone in your jaw and found that there is not enough to continue with a dental implant. Next your dentist will discuss the different types of bone graft with you and decide which will be the most suitable for you.
Once this has been decided the bone graft can be performed. For this the dentist will cut the gum at the site of the bone graft and create flap of skin. When the jaw bone is exposed the dentist will place the bone to be grafted onto the site and cover it with a protective membrane. This membrane is used to protect the bone from any microbiota (germs) found in the mouth and ensure that the area is perfectly clean to encourage the healing process. Finally the flap of gum is replaced and stitched carefully back into place. Healing time for a bone graft can vary from patient to patient but on average it is around 4 months. Patients are also given a course of antibiotics to take in the days following their bone graft. Antibiotic mouthwashes are also prescribed to preserve the health of the gum covering the bone graft.
Dentists can check on the success of the bone graft by performing x-rays to determine the height and width of the new bone. Once this has been confirmed as satisfactory, and the site of the bone graft is totally healed, the next stage of the dental implant process can begin.
Types of bone graft
Autografts – this is one of the most successful bone grafting techniques. Bone is taken (harvested) from the body of the patient (usually from the hip or the mouth) and this is then grafted onto your jaw bone. As harvested bone comes directly from the body of the patient, autografts tend to be the most successful form of bone graft as the harvested bone is compatible with the jaw bone.
Advantages of Autografts
No risk of disease being transferred – as the bone comes from the patient themselves there is no risk of a disease being passed on from a donor.
Little or no risk of the bone graft being rejected by the body
Using bone harvested form the patient encourages new bone growth
Disadvantages of Autografts
Not all dentists will perform this procedure
There is a need for two operations, one to harvest the bone and another to perform the graft
Patients may be quite sore on the site where the bone was harvested from and this can last for some time
Xenografts – these use bone that is harvested from animals, usually cows. This bone is processed to make it sterile and totally biocompatible. Animal bone behaves like filler and eventually a patient’s body will replace this with natural bone.
Advantages of Xenografts
Only one procedure is needed as the bone is not being harvested from the patient
Natural bone growth is encouraged
Disadvantages of Xenografts
Minimal risk of bovine spongiform encephalopathy due to the fact that all organic components of the bone are extracted
Many people are put off by the fact that bone from an animal is used for this type of graft
Allografts - these grafts are taken from human bone donors in the same way that organs are taken from donors in the event of their death. Bone which is harvested in this way will be put through various tests and sterilisation techniques to ensure that it is safe to be used as a graft. After the donor bone is placed in the jaw bone it will eventually be converted into natural bone and the jaw bone will be rebuilt.
Advantages of Allografts
Only one procedure needs to be performed as no bone is being harvested from the patient
Natural bone growth is encouraged
Disadvantages of Allografts
Risk of immunogenic reactions
Disease transfer can’t be totally ruled out
Bone from a donor can be slower to integrate into the natural bone
Harvesting the bone from a donor can weaken it by up to 50%
Some people do not like the idea of using donor bone for this procedure
Alloplastic grafts – these grafts are man made from synthetic materials, normally a type of calcium phosphate as this mimics natural bone. Grafts of this kind can be replaced, over time with natural bone as they are resorbed into the body and encourage natural bone growth. Some alloplastic grafts are made from material which cannot be resorbed by the body and instead these will act as a scaffold on top of which natural bone can be built.
Advantages of Alloplastic grafts
No risk of disease transfer
The dentist can obtain exactly the right amount of synthetic bone to graft successfully
Only one procedure is required for the graft
Alloplastic grafts are available in various sizes and shapes and this can be further refined for a perfect fit
Alloplastic grafts are made out of biodegradable material so it is safe to be used in the body
Disadvantages of Alloplastic grafts
Sometimes alloplastic grafts are weakened by the procedure
There is a slight risk that the body will reject the graft
Cost of bone grafting
It depends on the amount use to be graft.
It ranges $ 1,000 per 1ml bone material (Php 45,000)