Dental Implants - Bone grafting and regeneration procedures

Bone volume to accommodate dental implants is an important consideration when planning implant treatment. Any deficiencies in jaw bone structure can be resolved using a number of bone augmentation techniques to either facilitate the placement of an implant, or to improve the aesthetic outcome of implant treatment by improving the contour of the supporting structures.

Local augmentation using anorganic bovine bone (Bio-Oss TM)

This is the most straightforward grafting procedure, often called “guided bone regeneration”. The bone graft material is sourced from specially selected cattle and the patient does not require additional procedures to use their own bone. Bio-Oss has been used successfully for over 15 years and is used in specialist centres worldwide. To stabilise the Bio-Oss graft material a resorbable collagen membrane is sometimes required.

What is Bio-Oss?
How does Bio-Oss work?
Is Bio-Oss safe?
How long does it take for new bone to form around the Bio-Oss graft?
What is Bio-Gide?

Sinus lift procedures

In the posterior part of the maxilla (upper jaw) bone volume for implant treatment is often inadequate. To increase the bone in the maxilla a sinus lift procedure involves placing bone-graft material (often Bio-Oss) in the maxillary sinus to increase the height and width of the bone available for implant placement. On some occasions the sinus lift procedure and installation of the dental implants can be carried out as a single procedure for the patient, so only one operation is required.

Special piezo-electric instruments are used for these procedures to handle the delicate structures involved. Your surgeon will advise you on the merits and risks of sinus lift procedures in your particular situation.

Low sinus floor
Low sinus floor; no space for a dental implant placed around the implant
Space for a dental implant after sinus lift
Space for a dental implant after sinus lift

Autogenous bone graft procedure

This procedure involves using the patient’s own bone. This bone is considered to be the ‘gold standard’ in grafting procedures because the patient’s own bone will have better healing properties and acceptance by the body.

In many instances, bone can be harvested and collected prior to or during implant bed preparation and re-used to repair any bone defect around the implant. This technique is particularly useful in managing some challenging cases which can otherwise be very difficult to treat and is much less traumatic for the patients.

On other occasions, if more bone volume is required, it involves using bone from another part of the patient’s mouth, mostly from back of the lower jaw. This harvested bone block will be fixed to the site of the defect and it needs to be left to heal up for at least four months before placing the implant. The implant will take three further months to integrate to the new bone. As a general rule, the augmented site using patient’s own bone will have a shorter healing period compared to a graft using biomaterials.

Grafting is a highly skilled surgical procedure and several techniques have been developed in this field of surgical dentistry. Your surgeon will advise you as to the relative merits and risks associated with this procedure in your particular situation.

Read our case study in the European Journal of Implantologists by our dentist Younes Khosroshahy

Tooth loss and bony defect prior to implant treatment
Preoperative, site needs grafting for implant
Post-operative image three months after autogeneous bone graft and implant placement
Bone volume recreated with bone graft
Post-operative image three months after autogeneous bone graft and implant placement
X ray of implant in grafted site
Post-operative image three months after autogeneous bone graft and implant placement
Final crown to restore missing tooth on implant

Alternatives to bone grafting

Treatments such as the ‘All On 4‘ implant reconstruction involve using specially designed tilted implants to engage in the patients existing bone structure and can in some cases be an alternative to bone grafting.  Implant design has improved so bone can be expanded helping reduce the need for bone grafting.  Specially designed short implants can also be used to replace missing teeth in areas lacking bone height.  Hospital Lane Dental and Implant Clinic uses Nobel Active implants which have special design features to help secure implants for patients with reduced bone volume.  Your dental surgeon will advise you of various approaches that may help your treatment outcome.

 

Before the implants
Before the procedure
Placing the implants
Placing the implants
Attaching the bridge
Attaching the bridge
The Beautiful Results
The Beautiful Results

Zygoma implants

The most common area patients have a lack of bone is in the posterior aspect of the maxilla (upper jaw). In these cases if there is insufficient bone to utilise the ‘All On 4’ approach with tilted implants in the jawbone, there is the possibility of using Zygomatic implants to help secure the dental implant bridge.

This is a specialised procedure which can be carried out at Hospital Lane and uses longer implants which are attached to the cheekbone. When suitable, this treatment can be carried out to allow patients to have same-day fixed teeth. Your dental surgeon will be able to discuss important considerations regarding this option.

Zygoma - stability,precision and barrier
Schematic of two Zygoma implants and four anterior implants
3d Zygoma implant
Computerised planning with Nobel Clinician