Some of our Oral/ Facial procedures in The Woodlands

BONE GRAFTING


Permanently Replacing Missing Teeth

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 aesthetic appearance.

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.

  • Major Bone Grafting
  • The importance of teeth for jaw bone health
  • Reasons for jawbone loss & deterioration
  • About Bone Grafting types
  • About Ridge Augmentation
  • What is a Sinus Lift?
  • Nerve Repositioning
  • Socket Preservation
Major Bone Grafting

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained 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 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 patients 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.

The importance of teeth for jaw bone health

When one or more teeth are missing, it can lead to jawbone loss at the site of the gap. This loss of jawbone can develop into additional problems, both with your appearance and your overall health. You may experience pain, problems with your remaining teeth, and altered facial appearance, and eventually even the inability to speak and eat normally.

In that same way that muscles are maintained through exercise, bone tissue is maintained by use. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or needs the jawbone, so it deteriorates and goes away.

Potential Consequences of Tooth and Jawbone Loss

  • Problems with remaining teeth, including, misalignment, drifting, loosening and loss
  • Collapsed facial profile
  • Limited lip support
  • Skin wrinkling around the mouth
  • Distortion of other facial features
  • Jaw (temporomandibular joint [TMJ]) pain, facial pain, and headaches
  • Difficulty speaking and communicating
  • Inadequate nutrition as a result of the inability to chew properly and painlessly
  • Sinus expansion
Reasons for jawbone loss & deterioration

When an adult tooth is removed and not replaced, jawbone deterioration may occur. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or needs the jawbone, so it deteriorates and goes away.

The rate the bone deteriorates, as well as the amount of bone loss that occurs, varies greatly among individuals. However, most lost occurs within the first eighteen months following the extraction, and continues throughout life.

Periodontal Disease:

Periodontal diseases are ongoing infections of the gums that gradually destroy the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. While there are many diseases which affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues, and are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it always precedes periodontitis.

Dentures/Bridgework:

Unanchored dentures are placed on top of the gum line, and therefore do not provide any direct stimulation to the underlying alveolar bone. Over time, the lack of stimulation causes the bone to resorb and deteriorate. Because this type of denture relies on the bone to hold them in place, people often experience loosening of their dentures and problems eating and speaking. Eventually, bone loss may become so severe that dentures cannot be held in place even with strong adhesives, and a new set may be required. Proper denture care, repair, and refitting are essential to maintaining oral health.

Trauma:

When a tooth is knocked out or broken to the extent that no biting surface is left below the gum line, bone stimulation stops, which results in jaw bone loss. Some common forms of tooth and jaw trauma include: teeth knocked out from injury or accident, jaw fractures, or teeth with a history of trauma that may die and lead to bone loss years after the initial trauma.

A bone grafting procedure would be necessary to reverse the effects of bone deterioration, restoring function and promoting new bone growth in traumatized areas.

Misalignment:

Misalignment issues can create a situation in the mouth where some teeth no longer have an opposing tooth structure. The unopposed tooth can over-erupt, causing deterioration of the underlying bone.

Issues such as TMJ problems, normal wear-and-tear, and lack of treatment can also create abnormal physical forces that interfere with the teeths ability to grind and chew properly. Over time, bone deterioration can occur where bone is losing stimulation.

Osteomyelitis:

Osteomyelitis is a type of bacterial infection in the bone and bone marrow of the jaw. The infection leads to inflammation, which can cause a reduction of blood supply to the bone. Treatment for osteomyelitis generally requires antibiotics and removal of the affected bone. A bone graft procedure may then be required to restore bone function and growth lost during removal.

Tumors:

Benign facial tumors, though generally non-threateningly, may grow large and require removal of a portion of the jaw. Malignant mouth tumors almost always spread into the jaw, requiring removal of a section of the jaw. In both cases, reconstructive bone grafting is usually required to help restore function to the jaw. Grafting in patients with malignant tumors may be more challenging because treatment of the cancerous tumor generally requires removal of surrounding soft tissue as well.

Developmental Deformities:

Some conditions or syndromes known as birth defects are characterized by missing portions of the teeth, facial bones, jaw or skull. Dr. Tabarini may be able to perform a bone graft procedure to restore bone function and growth where it may be absent.

Sinus Deficiencies:

When molars are removed from the upper jaw, air pressure from the air cavity in the maxilla (maxillary sinus), causes resorption of the bone that formerly helped the teeth in place. As a result, the sinuses become enlarged, a condition called hyperneumatized sinus.

About Bone Grafting types

Over a period of time, the jawbone associated with missing teeth atrophies 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.

With bone grafting, we now have the opportunity to not only replace bone where it is missing, but also 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.

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 live bone, meaning it contains living cellular elements that enhance bone growth.

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 in your best interest.

Allogenic Bone:

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 its 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:

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 are advantageous in that they do not require a second procedure to harvest your own bone, as with autografts. However, because these options lack autografts bone-forming properties, bone regeneration may take longer than with autografts, with a less predictable outcome.

Bone Graft Substitutes

As a substitute to using real bone, many synthetic materials are available as a safe and proven alternative, 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:

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. Tabarini will determine which type of bone graft material is right for you.

About Ridge Augmentation

What is a Ridge Augmentation?

A ridge augmentation is a common dental procedure often performed following a tooth extraction to help recreate the natural contour of the gums and jaw that may have been lost due to bone loss as a result of a tooth extraction, or for another reason.

The alveolar ridge of the jaw is the bone that surrounds the roots of teeth. When a tooth is removed, an empty socket is left in the alveolar ridge bone. Usually this empty socket will heal on its own, filling with bone and tissue. Sometimes when a tooth is removed, the bone surrounding the socket breaks, and it unable to heal on its own. The previous height and width of the socket will continue to deteriorate.

Rebuilding the original height and width of the alveolar ridge is not medically necessary, but may be required for dental implant placement, or for aesthetic purposes. Dental implants require bone to support their structure, and a ridge augmentation can help rebuild this bone to accommodate the implant.

How is the Oral Surgery Accomplished?

A ridge augmentation is accomplished by placing bone graft material in the tooth socket. It is often done immediately after the tooth is removed, to avoid the need for a second procedure later. Next, the gum tissue is placed over the socket and secured with sutures. Our Doctors may choose to use a space-maintaining product over the top of the graft to help restore the height and width of the space created by the tooth and bone loss, and into which new bone should grow. Once the socket has healed, the alveolar ridge can be prepared for dental implant placement.

A ridge augmentation procedure sis typically performed in our office under local anesthesia. Some patients may also request sedative medication in addition.

What is a Sinus Lift?

The maxillary sinuses are behind your cheeks and on top of the upper teeth. These sinuses are empty, air-filled spaces. 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.

The key to a successful and long-lasting dental implant is the quality and quantity of jawbone to which the implant will be attached. If bone loss has occurred due to injury or periodontal disease, a sinus augmentation can raise the sinus floor and allow for new bone formation. A sinus lift is one of the most common bone grafting procedures for patients with bone loss in the upper jaw. The procedure seeks to grow bone in the floor of the maxillary sinus above the bony ridge of the gum line that anchors the teeth in the upper jaw. By strengthening and growing bone in this location, dental implants can be placed and secured in the new bone growth.

Am I a Candidate for a Sinus Lift Procedure?

A sinus lift may be necessary if you:

  • are missing more than one tooth in the back of your jaw.
  • are missing a significant amount of bone in the back of your jaw.
  • are missing teeth due to a birth defect or condition.
  • are missing most of the maxillary teeth, but require support for dental implants.
Nerve Repositioning

The inferior alveolar nerve which gives feeling to the lower lip and chin may need to be moved in order to make room for placement of dental implants to the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and second premolar, with the above-mentioned secondary condition. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever). Usually other, less aggressive options are considered first (placement of blade implants, etc.).

Typically we remove an outer section of the cheek side of the lower jawbone in order to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area, and slightly pull it out to the side. At the same time we place the implants, well be tracking the neuro-vascular bundle. Then the bundle is released and placed back over the implants. The surgical access is refilled with bone graft material of the surgeons choice and the area is closed.

Socket Preservation

Preserving Your Jaw Bone after Extraction

Removal of teeth is sometimes necessary because of pain, infection, bone loss or fracture of the tooth. The bone that holds the tooth in place (the socket) is often damaged by disease and/or infection resulting in deformity of the jaw after the tooth is extracted. In addition, when teeth are extracted, the surrounding bone and gums can shrink and recede very quickly after the extraction resulting in unsightly defects and collapse of the lips, and cheeks.

These jaw defects can create major problems in performing restorative dentistry whether your treatment involves dental implants, bridges or dentures. Jaw deformities from tooth removal can be prevented and repaired by a procedure called socket preservation. Socket preservation can greatly improve your smiles appearance and increase your chances for successful dental implants for years to come.

Several techniques can be used to preserve the bone and minimize bone loss after an extraction. In one common method, the tooth is removed and the socket is filled with bone or bone substitute. It is then covered with gum, artificial membrane, or tissue stimulating proteins to encourage your bodys natural ability to repair the socket. With this method, the socket heals eliminating shrinkage and collapse of surrounding gum and facial tissues. The newly formed bone in the socket also provides a foundation for an implant to replace the tooth. If your dentist has recommended tooth removal, be sure to ask if socket preservation is necessary. This is particularly important if you are planning on replacing the front teeth.


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Facial Trauma
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Dr. J. Enrique Tabarini and Dr. Oscar Muñiz offer oral and Maxillofacial surgery services to The Woodlands and the Houston area including: Magnolia TX • Spring TX • Conroe TX • Tomball TX • Grangerland TX • Aldine TX • Oak Ridge TX • Spring TX • Montgomery TX


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