Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone.

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.

Onlay 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.

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.)

The new bone is placed over the prepared surface of the existing bone.  In addition, special membranes may be utilized that protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.

Sinus Lift/Sinus tapping Procedure

The maxillary sinuses are above upper back teeth. 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. When the sinus wall bone of the sinus floor is thin, a dental implant of proper length can not be placed.

The solution is called a sinus graft or sinus lift graft. This is to increase the vertical bone in the sinus area so dental implants of appropriate length can be placed. After opening sinus area of the missing teeth, the sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. 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 dentures.

If bone loss around the sinus is minimal, a sinus tapping technique can be used to avoid the sinus lift procedure described above.  This involves tapping the bone during dental implant site preparation to slightly lift the sinus membrane around the tip of the implant area.  A small amount of bone grafting material can be placed before placement of the dental implant.

Ridge Expansion

After teeth are removed, the bony ridge of the jawbone may become thin due to resorption or bone loss.  Bone grafts may be placed on the top and the sides of the bone to increase the height and width as described above.  Ridge expansion is a technique use to avoid the traditional onlay bone grafting.  This procedure is used to expand the bone by mechanical means after an incision is made in the bone.  Implants can be placed immediately or a bone graft material can be placed to keep the bone in the new expanded position before implant placement.

Nerve Repositioning

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. 

In many cases, we also 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. Growth factors (Platelet Rich Plasma) from your own blood can also be used 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.

Pre-Prosthetic Surgery

The preparation of your mouth before the placement of a prosthesis is referred to as pre-prosthetic surgery.

Some patients require minor oral surgical procedures before receiving a partial or complete denture, in order to ensure the maximum level of comfort. A denture sits on the bone ridge, so it is very important that the bone is the proper shape and size. The bone may need to be smoothed out or reshaped. 

Occasionally, excess bone may need to be removed prior to denture insertion.

One or more of the following procedures might need to be performed in order to prepare your mouth for a denture: