Top Dentist - Prosthodontics
Milwaukee Cosmetic Reconstructive Implant Dentistry
Complex Bone Graft Surgery
The loss of critical jawbone material, for both upper and lower (maxillary and mandibular, respectively) can occur for a number of reasons or causes.
Our Bone Loss page discusses in detail popular causes including resorption, untreated extractions and periodontal disease.
Bone grafting is the procedure of choice for treating deteriorating bone material and especially for preparing dental implant sites that can lead to successful replacement of missing teeth, despite the loss of bone mass.
The picture sequences and accompanying technical discussion that appears here provides an outline of a bone grafting procedure used by Dr. Richard that does not use purchased bone graft material or matrixes, cadaver bone or donor bone but rather healthy bone material that is extracted from a patient's chin.
Using (autogenous) bone eliminates a large number of possible tissue rejection problems that can routinely occur in certain types of grafting surgeries. As with all implant surgeries, a focus is maintained on treatment choices that maximize predictability for success.
Using a person's bone, via chin block or ramus grafts, both are simply used to take bone where there is an abundance and move it to where it is needed to provide volume for supporting an implant.
Xrays are used to evaluate the existence of bone deterioration issues and clearly reveal to the patient what areas may require treatment.
Our first photo, a panorex, shows mini-titanium screws that are holding in new grafts in 3 different locations. There are 2 screws for each block of bone added.
Many implant surgeons, as we do in our office, employ the use of special agents and materials to accelerate the growth of grafted tissues and promote rapid and more thorough healing.
Dr. Winter often uses Plasma Rich Protein (PRP) as a method for utilizing Bone Morphogenic Proteins (BMP) to speed up healing, promote growth of new tissues and decreasing healing time during pre-implant site development.
Deficient areas are a result of disuse atrophy, and surgical bone loss. These sites are exposed, roughened up to promote bleeding which is needed to wet the new bone and promote uptake of nutrition for the newly added bone material.
The ascending ramus or area of bone behind the wisdom teeth is another site where bone can be harvested and used to create width and height for new implant placement procedures.
Demineralized freeze dried bone and bovine bone can be used in special applications that eliminates the use of artificial fillers that some implant specialists often use.
In our office we, whenever prudent, we use a special bone crusher that is used to create a compound of prepared bone material (the patient's own) that is used to fill in the spaces, thereby overcoming potential problems that can arise with artificial grafting materials. This device can be seen in the last photograph.
Reflecting the gums under the lower teeth exposes the mental nerves, and allows the dentist to see the proposed size of an area for bone harvesting, while paying attention to the position of nerves that need to be left undisturbed.
Once these anatomical sites are identified, small perforations are made to outline the grafting margins.
Then the dots are connected, the appropriate sized area of needed bone is removed.
Small holes are then drilled in the bone for small titanium screws that afix the bone to the desired surgical site.
The sectioned mandibular graft, ready for removal will insure adequate bone for the new site.
This is a painless procedure, with bone filling in the area, through self-regeneration, in a few short months.
There is no pain, during or after the procedure, according to several patients that have undergone the procedure.
Slight bruising and swelling are normal post operative sequelae, but are short in duration.
The next photo in our treatment series shows the results of a bone graft site preparation for the lower jaw.
Titanium screws are small and will be removed at the next stage of surgery during implant placement. The screw holes will also fill in with newly generated bone, over time.
Note the contours of bone that are achieved. The key to long term successful implant placement is having enough bone to hold the implants during function.
The next picture of a dental implant site preparation represents the posterior area of the upper (maxillary) jaw.
For this patient, the upper eye tooth lost so much bone, that an implant couldn't have been considered without a graft.
Note the loss of bone around the lateral incisor (next to the front tooth). Our doctors added about 3 millimeters of additional bone in height and width.
Sometimes, a combination of grafting procedures are needed to overcome severe bone loss.
They may include sinus lifts, bone grafts from areas inside the mouth, hip, tibia, or donated bone.
There can also be a need for freeze dried demineralized bone and/or bovine bone. Combination treatments, when used, focus on maximum use of the autogenous (patient bone) and using materials that promote the best opportunities for rapid and thorough healing.
The bone crusher, pictured here in our last photo, enables our doctors to create filler for pockets and filling in around a graft.
When there is insufficient bone for grafting or the site is not suitable for grafting, mini-implants may be considered so that sites can be implanted without more elaborate grafting procedures.
While these mini-implants won't provide the same surface area as traditional implants, they nonetheless provide additional treatment options our patients can select from that can eliminate the requirement for extensive grafting.
The suitability of a mini dental implant versus bone grafting is determined on a case by case basis, taking into consideration the location of the mini implant and the physical forces operating. Biting and chewing forces vary significantly between posterior and anterior regions of our jaws.
Listen to and watch a series of video clips of a bone grafting patient describing her experiences of undergoing the complex treatments and how she feels about the success she experienced.
Patients who have questions about bone grafting procedures and available technologies for different types of tooth replacement or implant needs are invited to call our office at 414-464-9021 to arrange a complimentary evaluation to learn more about current state-of-the-art solutions.
Our nearby Illinois patients, as well as patients from Minnesota, Indiana and other areas of the Midwest are encouraged to contact Dr. Richard directly with our on-line Ask The Dentist form... to get more information about what is possible in rehabilitative reconstructive dentistry.
See more examples of cosmetic and aesthetic dentistry including porcelain crown and veneer makeovers, diastema repair, tetracycline stain whitening and gum contouring at our Hampton Dental Associates Photo Gallery. More complex reconstructive dentistry can seen at our Wisconsin Prosthodontics Gallery.