Bone Grafting

Did you know…

when a tooth comes out, the bone beneath begins to gradually deteriorate?

Waiting too long to replace a tooth can raise the risk of bone loss, making it more difficult to attach dental implants and replacement teeth. Bone loss can also cause the facial structures to change and cave inward undesirably.

However, those who do not qualify for dental implants because of low bone mass may qualify for bone grafting to strengthen the bones and help them eventually receive implants. Similarly, those with receding or unhealthy gum tissue may be candidates for soft tissue grafting, which also improves one’s chances to qualify for dental implants in the future.

What is Bone Grafting?

The bones in the upper and lower arch of the mouth are responsible for supporting the teeth. When one or more teeth fall out, bone resorption in these areas naturally occurs. Unfortunately, insufficient bone mass can prevent those who want dental implants from qualifying for the procedure because the bone is not strong enough to hold onto the implant.

Bone grafting can help improve bone mass by filling in these weak areas with bone harvested from the patient’s own body, synthetic material, or bone from a cadaver or animal. Bone grafting promotes new bone growth that can eventually support a dental implant.

How Missing Teeth Affect Jawbone Health

When one or more teeth are missing, it can lead to bone loss in the jaw and cheekbones. This loss of bone can cause further problems, both with your appearance and your overall health. You may experience pain, problems with your remaining teeth, altered facial appearance, and if extensive, even the ability to speak and eat normally.

Just like muscles stay strong through exercise, bone tissue is also stimulated by use. Natural teeth are embedded in bone, and stimulate the bone tissue through activities such as chewing and biting. When teeth are missing, the part of the bone that anchors the teeth in the mouth no longer receives the necessary stimulation it needs and so it begins to break down.

Problem Tooth and Bone Loss Can Cause:

• Loosening of surrounding teeth leading to loss, misalignment, or drifting
• Caved-in facial structure
• Reduced lip support
• Skin wrinkles around lips
• Distortion of other facial features
• Jaw (temporomandibular joint (TMJ) pain, facial pain, and headaches
• Difficulty speaking and communicating
• Inadequate nutrition if unable to chew properly and painlessly

Causes of Bone Loss and Deterioration

The following are the most common causes of jawbone deterioration and loss that may require an oral bone grafting procedure:

Tooth Extractions
Whenever a permanent adult tooth is removed and not replaced, bone deterioration may occur as mentioned above. The rate at which the bone deteriorates, as well as the amount of bone loss that occurs, can of course vary among individuals depending on age and overall health. Most loss, however, occurs within the first year and a half following the extraction but can continue throughout life.

Gum (a.k.a. Periodontal) Disease
Periodontal diseases are conditions of the gums that gradually loosen the roots and nutrition of your natural teeth making them more likely to fall out. Most cases caused by plaque-induced inflammation are divided into two categories: gingivitis and periodontitis. Gingivitis is the less serious of the diseases but always comes before periodontitis.

Too much dental plaque is what will lead to gingivitis. Plaque is composed of food particles and various types of bacteria, which stick to your teeth at and below the gum line. Bacteria love plaque and will eventually cause infection and inflammation of the gums. Gums then become tender, swollen, and often bleed easily. If this goes on for too long and brushing or flossing is neglected, the gums will start to separate from the teeth causing gaps to form where more plaque and bacteria can develop.

If gingivitis progresses into periodontitis, the supporting gum tissue and bone that holds teeth in place weaken. This can then lead to loosening and subsequent loss of teeth.

Dentures and Bridges
Most dentures are unanchored and sit on top of the gum line, and therefore do not provide any direct stimulation to the underlying bone. The lack of stimulation causes the gum and bone below to deteriorate and weaken. Bone loss can become so severe that the shape changes and dentures cannot even be secured with strong adhesives. Usually, a new set or other replacement option is needed. Most often this can be avoided with regular denture care, repair, and refitting. However, dentures that are supported by anchors will effectively stimulate and preserve bone and don’t usually have these issues.

With bridges, the teeth on either side of the appliance provide sufficient stimulation to the bone, but the portion of the bridge that spans the gap where the teeth are missing receives no direct stimulation. Bone loss can occur in this area.

Trauma
When a tooth is knocked out or broken to the extent that no biting surface is left below the gum line, bone stimulation also stops and bone loss can occur. Bone grafting may be necessary to reverse the effects of bone deterioration and stimulate new bone growth in traumatized areas.

Misalignment
Misalignment of teeth, overcrowding and other issues such as TMJ problems can also create abnormal physical forces that interfere with the teeth’s ability to grind and chew properly. Over time, this can affect bone health and strength which in turn can lead to instability of the teeth.

Osteomyelitis
Osteomyelitis is a bacterial infection that develops inside bony tissues. It is a serious infection and one can become really sick from it. Additionally, the infection can damage the bone leaving it weak and brittle. Treatment for osteomyelitis requires antibiotics and removal of or surgical cleaning of the affected bony tissue. Bone grafting is often necessary to restore the structure and function of the bone.

Tumors
Although generally non-threatening, benign facial tumors can grow very large and invade the jaw bone requiring the removal of a portion of the jaw. Malignant oral cancers may also spread into the jaw, requiring reconstructive jaw surgery to restore form and function.

Developmental Deformities
Certain conditions or syndromes can result in underdeveloped portions of the teeth, facial bones, jaw, or skull. Dr. Hinckley is often able to perform a bone graft procedure to restore bone function and growth where needed in these patients.

Sinus Deficiencies
When molars are removed from the upper jaw, sometimes air pressure from the air cavity in the maxilla (maxillary sinus) causes weakening of the bone that formerly held the teeth in place. As a result, the sinuses become enlarged, a condition called hyperpneumatized sinus.

This condition usually develops over several years and may result in insufficient bone for the placement of dental implants. To remedy this, Dr. Hinckley can perform a procedure called a sinus lift to treat enlarged sinuses and make the bone more suitable for implants.