Tissue Grafting for Implants
Our goal is to make all of our patients an ideal candidate for dental implant reconstruction. For many patients, after tooth removal, there is a loss of the bone or soft tissue in the area needed for ideal placement of the implant or implants. Depending on when the tooth was lost or the reason it was lost, we may need to do some rebuilding for the implant to be placed. How your teeth fit together is a pretty balanced system, and that all depends on where the gums and bone that supports the teeth exists. We will work with your restorative doctor to determine the ideal position of the tooth, and from there plan where any bone or soft-tissue grafting needs to be performed.
There are a number of methods and materials used to prepare you for implant placement. Your CMF doctor will work with you to choose the best way to get you to your dental rehabilitation goal. Most of these procedures are able to be completed in the office with minimal postoperative discomfort.
Often the best time to plan your implant reconstruction is while the teeth are still present. When a tooth is removed, your body acts quickly to heal from the sides and bottom of the site. In many patients, that process is complicated by a previous infection or thin bone. In this scenario, Dr. Osborn, Dr. Malouf or Dr. Wardius will often place a graft at the time of extraction to give your body the best chance to preserve the bone width and height. This will often maximize the chances that an implant can be placed. Once the graft it placed, we let it heal for about three months at which time most people are ready for implant placement.
Delayed Grafting with Ridge Augmentation
The bone that houses your teeth exists specifically to do just that; when a tooth is removed, that bone will often disappear over the course of several months. What you may be left with is a site that is inadequate for implant placement. Whether it is to widen the space for the implant, increase the height of the bone, or to place it further from the vital structures in your jaw, we are equipped to use whatever technique is best to reconstruct your jaw. This can often be done by layering bone on top of your native jaw which your body will incorporate (Ridge Augmentation). In some cases, we need to use a more sturdy form of material so that as it heals, the graft isn’t compressed or moved. Your CMF surgeon has a couple of options to do this and is happy to give you more detail should you need this type of augmentation.
In the upper jaw, there is a sinus in your cheek that is right above your back teeth. Often this sinus can expand over time and when a tooth is lost, this can lead to a lack of space for a dental implant. Either when a tooth is removed, or as a delayed procedure, we are able to lift up and build up the height we have to place an implant. A common question is “why not just place a shorter implant” which is sometimes exactly what we do. In those that a shorter implant will lead to possible failure of the implant, we will need to perform the sinus augmentation. To do this, we may be able to go from the socket of the tooth that was removed, or by making a window into the sinus. Either of these procedures are routinely performed by your CMF surgeon and they will explain to you the reason and benefit of doing whichever is best. They may also discuss with you if the sinus augmentation can be done at the same time as implant placement, or they need to be staged over a couple of months.
Your CMF doctors are unique in their training in many ways, but in particular with how to manage the sinuses. There are a number of providers who will perform sinus augmentation, but very few who can manage the health and normal function of the sinuses should they be irritated by the procedure. Not only do we routinely perform surgery in and around the sinus, but our background in dentistry allows us to understand how placement of an implant relates to the health and function of your sinuses.
There is a nerve that runs through your lower jaw, giving sensation to your lip and chin. Many of the grafting or reconstructive procedures that we perform are designed to avoid this nerve. That is true in dental implant placement as well. One of the main risks of having an implant in the lower jaw is that this nerve can be compressed. Often it is well away from where an implant will be placed which reduces that risk dramatically, but in some patients the nerve is in a position that requires management. In most patients we are able to augment the bone sufficiently to avoid the nerve, but in some patients, we need to relocate the nerve anatomically. This means that we isolate the nerve and remove it from the bone to place it out in the tissue so that an implant can be placed. This is not commonly necessary, but your CMF surgeons can explain the procedure should you need this performed.