Bone Grafting Overview
For a brief narrated overview of the bone grafting process, please click the image below. It will launch our educational MiniModule in a separate window that may answer some of your questions about bone grafting.
Minor and Major Bone Grafting
Over a period of time, the jaw bone associated with missing teeth atrophies or 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.
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 esthetic appearance.
Minor Bone Grafting
Smaller areas of missing or atrophied bone in the jaws can be reconstructed by using bone taken from various sources including the patient’s own bone harvested from the jaws or by using grafting products such as allogeneic bone (sterilized, processed cadavaric bone), xenografts (sterilized, processed animal bone) and alloplastic materials (synthetic materials supporting natural bone growth).
Minor bone grafting procedures are usually performed in the office under local anesthesia and, often, with intravenous (IV) sedation to ensure comfort during the surgery.
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 patient’s 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.
Sinus Lift Procedure
The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. 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.
There is a solution and its called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.
The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.
If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation will have to be performed first; then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In the Ridge Expansion procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the dental implant.
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 2nd premolar, with the above-mentioned secondary condition. Because the Nerve Repositioning 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 jaw bone 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 will place the implants. 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.
These procedures may be performed separately or together, depending upon the individual’s condition. As stated earlier, there are several areas of the body that are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. When we use the patient’s own bone for repairs, we generally get the best results.
In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to promote the patients own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.
These surgeries are performed in the out-office surgical suite under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.
Atlantic Oral & Maxillofacial Surgery Associates
I was home for Christmas break from school. I had let my wisdom teeth pain go for a while, but could wait no more. I called Dr. Jungels office and accommodated me immediately with a consult and surgery for my impacted teeth. The staff were very nice and Dr. Jungels was extremely knowledgeable as he explained everything to me about the surgery. Very professional and personalized care given before, during and the week following the surgery. Doctor called the day after surgey to see how I was doing. Such a rarity nowadays. Would highly recommend this practice if you want to make an unpleasant experience, as pleasant as humanly possible.
- Kyle T
I had a stress crack in a molar from my orthodontic band which I didn’t have crowned— of course over time it worsened and needed to be pulled. Dr. Jungles was fabulous and I only had to be numbed! The whole procedure was quick and relevantly painless! He provided instructions, followed up with me and the whole staff was honestly the best I ever used! I love this office and would highly recommend!
- Ginamarie D
Very good experience, friendly and helpful staff. Dr. Jungles was excellent,will return if needed
- Frank L
Office accomodated me the next day. Was in pain. Staff and Doctor were great. Explained options, procedure and after care. Made an unpleasant situation as comfortable as posssible. Thank You.
- Thomas C
His concern for me to keep me calm. He explain what he was going to do and talk to me during the procedure which did keep me calm. I appreciate his patients
- Phyllis E
I recommend them , A+++
- Robert M
Happy with the care I received!
- Gillian M
Staff was very caring and friendly. Dr. Jungles made me feel calm and as comfortable as possible during procedure.
- Cheryl S
Excellant doctor and staff made me feel very relaxed
- joe nigro n
Doctor Jungles explained condition and what to expect with the surgery and recovery.
All options were presented and insurance coverage and co-pays explained with no “surprise” additional fees.
Surgery out come was excellent.
I highly recommend Dr. jungles and his entire staff was wonderful!
- Gary S.
I was refered to this Dr. and I can only say that I need to thank that person because this office was a complete joy.
- Kevin P.
Everything was great. Two convenient locations too.
- Joe F.
Great job, quick, and barely any pain after all four removed.
- Sarah S
Excellent surgery and friendly staff. I had my wisdom teeth removed and recovery was smooth. Thank you, Dr. Jungels and staff for making me feel very safe and in good hands.
- Nastassia D.
I had gastric bypass surgery years ago, an after effect is that my teeth have began to fall apart, I was able to make an appointment, be seen, and have the bad teeth removed all within a week, I will be following up for the remainder of my teeth and would trust no one else!
- Stanley G.
I was in severe pain for over a year with exposed roots and nerves, I went here and in one appointment the teeth were removed as well as impacted wisdom teeth, I have severe anxiety and they took care of that with local sedation, I am now home recovering and can not wait until the extraction pain goes away so I can see how my new mouth feels
- Stanley G.
Quite amazing, actually. As professional, courteous and efficient as one could imagine.
- Alan M.
I was very pleased with my experience.
I had a great experience. I was so scared and anxious about the whole procedure. The doctor and his staff helped ease that a lot
Great office, I would recommend them to anyone seeking a pleasant and calm experience.