Dr. Lim - Board Certified Prosthodontist
Tooth loss occurs for many reasons; dental decay, root canal problems, fractures, periodontal disease and trauma. Additionally, at times teeth never develop. As a result of tooth loss, the bone melts away.
Bone grafting materials are used to rebuild and regenerate the bone providing sufficient bone in quantity and quality for implant placements and supporting tooth structure.
Gum Flap Surgery
When deep pockets between teeth and gums (6 millimeters or deeper) are present, it is difficult for a dentist to thoroughly remove the plaque and tartar. Gum flap surgery is a procedure where the gum flap is lifted away from the tooth. Diseased tissue and sometimes bone is removed. The rough surfaces of the tooth are then smoothed by root planing. The area is medicated and the gum flap is replaced and sutured allowing the bone and gum tissue to heal.
One of the goals of gum flap surgery is to reduce the depth of the periodontal pockets to make them easier to keep clean.
If a patient has an excess amount of tissue that connects the lower and upper lips to the jaw and gum line, a frenectomy procedure is performed to remove the excess tissue. A frenectomy is either performed inside the middle of the upper lip, which is called a labial frenectomy, or under the tongue, called a lingual frenectomy. Frenectomy is a very common dental procedure in the dental world and is performed both on children and adults.
A gum lift may be performed to create a more even gum line. Patients with a gummy smile can quickly and safely have unwanted tissue removed, thus exposing more tooth to shape a more attractive smile.
Bone grafting is commonly performed by an oral and maxillofacial surgeon to replace or augment bone in areas of tooth loss. Bone grafting to the jaws and facial structures may be necessary in a wide variety of scenarios. The most common bone grafts are facial skeleton and jaw procedures. Other common procedures include tooth extraction site graft, bone graft reconstruction and for a sinus lift. Shrinkage of bone often occurs when a tooth is lost due to trauma, severe caries, or periodontal disease. Additionally, bone loss may have already occurred due to infection or pathology around a tooth. There are many artificial biocompatible bone substitutes available; however, the best material for a bone graft is your own bone, which most likely will come from your chin, the back part of your lower jaw or your hip bone. The hip is considered to be a better source because the hip bone has a lot of marrow, which contains bone-forming cells. There are also synthetic materials that can be used for bone grafting. Most bone grafts use a person's own bone, possibly in combination with other materials.
To place the removed bone in the recipient site, little holes are drilled in the existing bone to cause bleeding. This is done because blood provides cells that help the bone heal. The block of bone that was removed will be anchored in place with titanium screws. A mixture of the patient's bone marrow and some other bone-graft material will then be placed around the edges of bone block. Finally, a membrane is placed over the area and the incision closed.
The bone graft will take about 6 to 12 months to heal before dental implants can be placed. At that time, the titanium screws used to anchor the bone block in place will be removed before the implant is placed.
When a tooth is lost, both bone and gum tissue compete for the vacant space. The gum tissue generates more quickly than bone, subsequently occupying the space. With a membrane placement we can keep the gum tissue from invading the space, which will ideally give the bone sufficient time to regenerate. Bone regeneration is often used to rebuild the supporting structures around the teeth, which have been destroyed by periodontal disease. Bone surgery may be used to attempt to rebuild or reshape bone. Grafts of the patient's bone or artificial bone may be used, as well as special membranes.
When a tooth is lost and not immediately replaced, the bone reacts to this event by 'shrinking back'. The bone becomes thinner from a width perspective and the bone height is frequently reduced. This process is known as bone resorption. In order to place implants, it is necessary to rebuild the bone width and height through regenerative surgical therapy. Bone grafting of the ridge is almost always required to enable accurate placement of dental implants. The grafting is completed utilizing tissue bank and/or synthetic bone particles combined with collagen membranes. It is a highly predictable procedure.
The human skull has several cavities or air spaces called sinuses. When the sinus is enlarged and intrudes on areas where we want to place dental implants, bone or bone growth stimulation material is placed into the sinus. This procedure only affects the maxillary sinuses, which are located just over the molar teeth in the upper jaw. The side of the maxillary sinus is opened and the bottom is raised so it will fill in with bone. Several months later, dental implants can be placed in solid bone.
An "Osteotome Lift" is a surgical procedure that raises the floor of the sinus directly over where the implant is placed. This can be done without actually opening the sinus.
In the back of the upper jaw bone dental implants are frequently needed. In order for a dental implant to be successful in this area of the mouth there must be sufficient bone height and width to connect (integrate) to the dental implant. When the upper back teeth are lost and not replaced the sinus cavity becomes enlarged destroying any bone that is left behind. This very large sinus is like a "giant air pocket" and not capable of supporting an implant. A procedure known as sinus grafting (sinus lift) is performed to create bone that will ultimately hold the implants within the sinus. Sinus grafting is an extremely common form of bone grafting.
When a tooth is extracted and an implant is to be placed (either simultaneously or in the future) it is always necessary to complete bone grafting within the residual sockets that are left behind after the roots of the tooth are removed. The shape of the tooth root is always different from the shape of a dental implant and hence there are always residual socket defects (holes) that must be filled in so that there can be excellent contact of the implant to the newly formed bone.
Soft Tissue Grafting
Root exposure resulting from gingival tissue recession may pose multiple problems for patients:
- Undesirable Aesthetics
- Root Sensitivity
- Impaired Oral Hygiene
- Increased Caries Susceptibility
- Teeth May Become Loose
A gingival tissue graft will restore the proper gum tissue structure around the tooth.