Bone Grafts and Sinus Lift

Bone grafting a minor surgical procedure that might sound terrifying. However, you may feel more relaxed once you understand it has evolved into a fairly simple procedure with improved technology and techniques.

WHAT IS BONE GRAFTING?

• Bone grafting is also known as regenerative surgery.
• A bone graft is a minor surgical procedure used to recreate bone in areas of the mouth where it has been lost due to periodontitis, traumatic extractions, infection, long-term denture wear, and other causes. In many cases, bone loss results from tooth loss: once a tooth is lost, the bone that supports it, called alveolar bone, will disappear or resorb.
• Grafting replaces lost bone and is possible because bone tissue has the ability to regenerate if given a proper environment to grow.

WHY WOULD I NEED BONE GRAFTING?

COMMON SCENARIOS WHERE BONE GRAFTING IS INDICATED:

• Save existing teeth. Severe periodontal disease causes bone loss. Bone grafting is done to add more support to teeth that have lost their alveolar bone.
• Extraction. When teeth are extracted, bone that supports the tooth is lost. To prevent this from happening, grafting is done at the time of extraction. This helps to maintain bone and gingiva (gum) height. It’s especially ideal if you are restoring the extracted tooth with an implant or another prosthesis.
• Dental implant placement. To replace a missing tooth or teeth with a dental implant/s, adequate bone support is needed for the titanium dental implant anchor. Bone grafting can be done to increase bone volume before implants can be placed, or at the time of dental implant placement. Sometimes we add bone to a previously placed implant.
• Aesthetic/cosmetic procedures. Bone grafting in some cases may be necessary to improve harmony between gum tissue and teeth to create a beautiful smile or enhance an existing one.

WHERE DOES THE BONE FOR GRAFTING COME FROM?

Per the FDA, bone grafting material is a substance such as hydroxyapatite, tricalcium phosphate, polylactic and polyglycolic acids, or collagen, that is intended to fill, augment, or reconstruct periodontal or bony defects of the oral and maxillofacial region.

THERE ARE SEVERAL TYPES OF BONE GRAFT MATERIALS. SOME COMMON SOURCES ARE:

• Bone from another site on the same patient
• Bone from an animal
• Bone from a cadaver
• Synthetic bone
• Growth factor additives

WHAT TO EXPECT WITH BONE GRAFT PROCEDURE?

Bone grafting is performed usually under local anesthesia. Sedation can be used for extremely anxious patients. Dr. Nodesh will place the sterile bone particles in the site as previously planned.

He will determine if a collagen membrane is needed to protect the bone graft material during healing. Either a resorbable or a non-resorbable suture will be used to secure the surgical site.

WHAT TO EXPECT AFTER SURGERY?

The patient may exhibit some swelling and bruising. Discomfort is usually minimal and may last only 1 or 2 days if instructions are followed. Written instructions and any prescriptions will need to be taken as instructed.

The surgeon may have additional specific instructions for various patients. Some soreness around the surgical area is expected. We will advise a follow-up visit to monitor healing.

WHAT IS RIDGE AUGMENTATION?

A common use for bone grafting is ridge augmentation. Ridge augmentation can recapture the natural contour of your gums and jaw after the loss of a tooth as a result of trauma, congenital anomalies, infection, or periodontal disease.

Achieving an ideal amount of gum and bone as a support for surrounding restorations or implants may require hard and soft tissue reconstruction. After the loss of one or more teeth, your gums and jaw bone may become indented where the tooth or teeth used to be.

This occurs because the jaw bone recedes when it no longer is holding a tooth in place. Not only is this indentation unnatural looking, it also causes the replacement tooth to look too long compared to the adjacent teeth, and this can create an area that is difficult to keep clean.

Ridge augmentation uses bone and tissue-grafting procedures to fill in the indented area of the jaw and gums, to leave you with a smooth gum line that coexists with your restoration or dental implant.

SINUS LIFT

WHAT IS A SINUS LIFT?

Sinus lift is a kind of bone graft procedure. It is performed when there is extreme bone loss on the patient’s maxilla (the part where the premolar and molar teeth are) or a pneumatized maxillary sinus (enlargement of maxillary sinus). This may require a bone graft as the sinuses are right above the upper teeth.

The sinus system has several parts, but it’s the maxillary sinuses around the cheek area which sit closest to our teeth. You might sometimes get a toothache when you have congestion or a bad cold; this is because the pressure on the sinuses transfers to the tooth roots in the upper jaw.

WHY DO I NEED SINUS LIFT PROCEDURE?

If you have been indicated for or need dental implants for replacing missing tooth/teeth, a sinus lift is needed if there is insufficient bone height in the upper molar/pre-molar region of your mouth.

The reason for a lack of bone may be several: You may have naturally large maxillary sinus/ jaw anatomy or there may be alveolar bone loss due to tooth/teeth loss.

WHAT DOES SINUS LIFT PROCEDURE INVOLVE?

Consultation with the prosthodontist, Dr. Nodesh, is the first step. A CBCT 3-dimensional scan will be made and evaluated by Dr. Nodesh and a radiologist to eliminate any pathology in the sinuses.

We will use state-of-the-art technology for surgical planning.

WHAT TO EXPECT ON THE DAY OF SINUS LIFT?

There are various techniques for individual cases and yours will be determined by Dr. Nodesh. A small window will be opened from under the gum tissue to gain access into the sinus floor; then the delicate membrane that lines the sinus floor will be pushed up and a bone graft will be placed in.

A protective barrier (collagen membrane) may be placed and secured with sutures. Depending on the type of sinus lift performed, dental implants may be placed on the same day, which may eliminate a second surgery and shorten the overall procedure by 3 to 4 months.

WHAT TO EXPECT AFTER A SINUS LIFT PROCEDURE?

Patients usually expect some swelling and bruising. Discomfort is usually minimal and may last only 1 or 2 days if instructions are followed. Written instructions as well as patient-specific instructions will be provided to you.

Some soreness around the surgical area is to be expected. Patients may feel congested for a couple of weeks, and over-the-counter decongestants will help relieve the discomfort. Dr. Nodesh will advise a follow-up visit to monitor healing.

HEALING AFTER SINUS LIFT PROCEDURE?

If sinus lift with bone grafting alone was performed, healing and bone turnover is usually around 5 to 7 months, following which an implant can be placed and further treatment continued.

If sinus lift with implant placement was performed, healing is usually around 3 to 4 months, following which restoration can be finished.