Bone Grafts And Reconstruction

In order to optimize comfort, function and esthetics, bone grafting is required to replace missing bony tissue, and in many cases support the placement of dental implants.

Bone grafting is a procedure where bone is transferred from one area or location and placed into a new location. The oral and maxillofacial surgeon can therefore “build bone” in areas where it is missing. In the practice of oral and maxillofacial surgery, the need for bone grafting presents itself in a multitude of situations.

At Dolman Oral Surgery, Dr. Robert M. Dolman has had extensive training and experience in the areas of bone grafting and reconstruction. He employs an evidenced-based approach utilizing the industry’s highest quality materials and standards of care.

Types of Bone Grafting

The typical needs for bone grafting can be best explained by dividing it into two main categories. Regardless of the group, the principles and protocols of grafting remain the same.

The first group includes minor bone grafting which typically falls within the parameters of oral surgery and can generally be managed in an office setting. These grafts are generally placed in preparation for future dental implants.

The second group will consist of major grafting which will fall within the scope of maxillofacial surgery and is usually performed in a hospital setting. These grafts are usually required to replace large bony defects resulting from trauma or pathology.

Where Does The Bone Come From?

The usual question is “Where Do You Get The Bone?” or “Where Does The Bone Come From?”

There are four graft choices:

  • Autogeous Grafts: The bone comes from within the same individual. In other words, the patient is his/her own donor.
  • Allografts: The bone comes from another human donor.
  • Xenografts: Donor bone derived from another species, usually bovine sources.
  • Synthetic Grafts: Bone created from Hydroxyapatite, Hydroxyapatite combined with B-Tricalcium phosphate, and Calcium Sulfate.

Minor Bone Grafting And Reconstruction

Bone grafting in this group of patients is generally performed in preparation for placement of dental implants. The basic requirement for the placement of a dental implant is having the adequate bone height and bone thickness. If either is lacking, then a bone graft may be required in order to allow for placement of an implant. Typical scenarios include the following:

  1. Socket preservation graft with guided bone regeneration: In these cases, a patient’s tooth needs to be extracted because the tooth is beyond repair. This may occur as a result of caries (decay,cavity), advanced periodontal disease (gum disease & bone loss), or trauma (broken or fractured tooth). Prior to extraction, Dr. Dolman will review tooth replacement options along with the associated risks/benefits, as well as durability and outcomes. If an implant is determined to be the best treatment, then a socket preservation graft is usually required. In preparation for an implant, a bone graft is advantageous because it optimizes the residual bone height and thickness and in so doing allows for the proper placement of the implant.
  2. Sinus lift procedure: Oftentimes in the back part of the upper jaw (posterior maxilla), the maxillary sinus dips downwards and reduces the amount of bone in the area. When teeth are missing, and the patient requires implants in this area, a sinus lift and bone graft may be required to create the height for implant placement. After careful clinical examination and appropriate x-rays, which may include a panoramic radiograph and possibly a 3-D I-Cat CT scan, Dr. Dolman will be able to determine the available bone for implant placement and the need for a sinus lift.
  3. Ridge augmentation: In the absence of a tooth or teeth, the bony ridge may be too thin for implant placement. In order to thicken the bone, an onlay graft may be required: A small block of bone is harvested from either the chin or the back of the jaw bone and the bone is tacked on to the thin site to improve the thickness. Other augmentations can be accomplished with a split ridge graft or distraction osteogenesis.

Major Bone Grafting and Reconstruction

Major grafting procedures are required when an individual loses part of the jaw bone. This can result from either a traumatic injury or a pathologic entity, usually a large cyst or tumor whether benign or cancerous.

The bony reconstruction in these cases will require advanced techniques, often requiring a multidisciplinary approach. Bone will usually be harvested from the hip bone or wrist bone or tibia (leg).

Dr. Dolman has lectured nationally and internationally on bone grafting and reconstruction and basic and advanced implant surgery. With his extensive training and experience, whether minor or major, Dr. Dolman will be able to comprehensively evaluate your grafting needs and in turn recommend the appropriate treatment.

As always, Dr. Dolman will carefully explain all risks and benefits of the proposed treatment. He will make sure that all of your questions and concerns are answered, and you will be treated in a caring, comfortable and attentive manner.