What does your
dentist mean when he says a Bone Graft is necessary to place your dental
implant?
The success
of a dental implant, it's ability to support a dental restoration,
is very much dependent upon how much bone is available in the site
where the implant is placed. There are lots of things that affect
the bone volume including things like periodontal disease, trauma
and infections and it is not unusual to open up a site in the mouth
for implant placement and find out that some of the critical supporting
bone is missing. No problem.... We have great techniques available
to us to replace missing bone. We can increase the height of bone
and the width of bone. We can fill in anatomical voids in bone thereby
creating new bone and we can fill in all sorts of defects that develop
when teeth are lost. We can even use grafting techniques to prevent
the loss of bone in circumstances where bone would normally be lost
like the extraction of a tooth.
Replacing missing
bone or adding to existing bone is very often essential to the success
of a dental implant and the ensuing restoration. The techniques to
do this are well documented and should be used when indicated by any
dentist who places dental implants. Most of us will have a good idea
when additional bone or bone repair will be necessary before actually
starting the placement of a dental implant and the patients should
be informed of this possibility. Sometimes, however, we do get fooled
and run into areas where unexpected bone grafting is indicated. As
long as the dentist is prepared to replace or add to the existing
bone and the patient understands the bone grafting procedure, there
should not be any problem with these techniques...
Types of Bone
Grafting:
There are many
ways in which bone grafting can be done. Sometimes it is as simple
as collecting bone when preparing an implant site and then reusing
the bone for grafting purposes. Whenever we can use the patients own
bone for repairs or additions, we will get the best results. In extreme
cases, bone can be harvested from areas outside the mouth. The most
common area is the hip. Needless to say, when this type of bone graft
is done, everyone has to be fully prepared and you would usually find
yourself in a hospital setting with a physician actually removing
the bone from your hip and your dentist placing it in the appropriate
areas of your mouth.
Very often,
we can use "bone in a bottle" to do bone grafting for dental
implants. This bone is specially prepared from cadavers or other sources
and used to get the patients own bone to grow into the repair site.
It is very effective and very safe. Sometimes synthetic materials
can be used to stimulate bone formation and sometimes we even use
factors from your own blood to accelerate and promote bone formation
in graft areas.
Very often,
bone grafting is done in combination with what dentistry refers to
as a "Barrier Membrane Technique". Membranes made out of
special materials are placed over bone graft sites to keep out the
types of soft tissue cells we do not want and promote the growth and
migration of cells which will turn into normal, healthy bone. These
membranes are very successful and are used quite a bit these days
to promote sound bone formation. The membranes are usually removed
at a later date, but sometimes they can be resorbed by the body and
disappear all on their own.
In addition,
it is not uncommon to use "screws" and "tacks"
to secure membranes and bone grafts at an implant site. Sometimes
these pieces will also have to be removed at a later date, but rest
assured that all of these components and grafting materials are safe
and effective and their use has gone a long way in increasing the
success rates of dental implants.
The Sinus Lift:
The human skull
has several cavities or air spaces which are called "sinuses".
They are part of the overall design of human beings to make the head
lighter so that it can be supported on our neck. Sometimes the sinus
are enlarged and intrude on areas where we want to place dental implants.
We cannot place a dental implant into the sinus because we would just
be placing it into an air cavity and nothing would hold it into place
(although, very often, implants that are placed securely into solid
bone will protrude a small way into the sinus) so when we encounter
this problem, we place bone or bone growth stimulating material into
the sinus.
This procedure
really only affects the maxillary sinuses which are located just over
the molar teeth in the upper jaw. There are no sinuses in the lower
jaw. When the maxillary sinus prevents the placement of an implant,
we merely open up the side of the sinus and raise the bottom portion
of the sinus so it will fill in with bone. We can then go back several
months later and place our dental implants in solid bone. Sometimes,
there is enough bone to place the implants at the same time that you
raise the floor of the sinus. This will save time.
There are some
more conservative ways to grow bone in the sinus. We can do what is
called an "Osteotome Lift" and just raise the floor of the
sinus right over where we are placing an implant. This can be done
without actually opening the sinus and healing and implant integration
will then proceed as if the sinus was not in the way. Sinus lifts
of all types have a high success rate and are commonly used today
for promoting dental implant procedures.
Costs of Bone
Grafting Technique:
There are two
potential downsides to bone grafting in conjunction with dental implants.
The first is that the process of bone grafting and the ensuing healing
period may add significant time to the procedure. The second problem
is the increased cost of these procedures. Most of you who come to
this site already know that I am very much in favor of keeping the
cost of dental implant work as low as possible. However, some people
let the costs get way out of hand when things like grafting get involved
because they tend to mystify these procedures and make them appear
to be very costly.
A bottle of
Freeze Dried bone cost about $95.00. Membranes cost between $35.00
and $150.00. Other instrumentation can cost several hundred dollars.
I use a sliding scale for grafting charges from $250.00 to $750.00
depending upon how much bone and other materials I actually use and
how difficult the particular job is. My fee for a sinus lift is $1250.00.
I have seen charges in other offices ranging from $2500.00 to $25,000.00
depending upon the type of grafts. I think that some people have used
"scare tactics" to inflate their fees for grafting procedures
and the best defense that the patients have is to be informed about
the process.
There is a new
wrinkle that has come on the market. The use of a platelet sediment
retrieved from the patients own blood can be very useful in promoting
bone graft development. Be aware that the equipment for this can cost
several thousands of dollars and that some dentists will tend to overuse
the technique to pay for their investment. I have already seen platelets
used in one gentleman who had more bone than he could possibly ever
need... The fee for the platelet treatment was an additional $2500.00!
LINKS
to more information about bone grafting:
General
Bone Grafting Technique:
Bone
Grafting Course:
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