Do you think of bone as a hard, rigid material that never changes? In fact bone remodels itself all the time: Your body is constantly depositing new bone cells and removing old ones. In the case of the bone that supports your teeth, this process can be helpful or harmful. For example, the jawbone's adaptability allows an orthodontist to move teeth into a better position with braces. But in the case of losing a tooth as an adult, the bone changes that result can have serious consequences.
When teeth are lost, the bone that used to surround them begins to melt away or “resorb.” Tooth-supporting bone can also be lost when you have periodontal (gum) disease. If you loose enough teeth and bone, your facial features will sag, giving you a more aged appearance; it can also complicate treatment to replace your missing teeth. Fortunately, with modern bone grafting-techniques, the bone that has been lost can be built up again. This can benefit both your health and appearance by strengthening your jawbone, allowing more effective tooth replacement, and increasing support to your facial features.
How It Works
Bone grafting, normally a minor surgical procedure done in the dental office, is used to build up new bone in the area of your jaw that used to hold teeth. A small incision is made in your gum to expose the bone beneath it, and then grafting material is added. Most often, the grafting material is processed bone that serves as a scaffold, around which your body will actually deposit new bone cells. The grafting material will eventually be absorbed by your body and replaced by your own new bone.
The grafting material needed can come from a variety of sources. Sometimes it comes from your own body. Very often, however, it is bone from an animal or human donor that is processed by a laboratory to make it sterile and safe. Grafting material can even be synthetic. It comes in a variety of forms: powder, granules, putty or even a gel that can be injected through a syringe.
Uses for Bone Grafts
Bone grafts are used in dentistry to accomplish the following treatment goals:
- Saving Teeth — When severe periodontal disease causes bone loss, teeth can become loose and at risk of being lost. In order to save them, Guided Tissue Regeneration (GTR) attempts to regenerate lost periodontal structures, such as bone, ligaments, and connective tissue attachments that support the teeth. This increases the bone support and helps keep the teeth in place.
- Tooth Extractions — After a tooth has been removed, it is very common to deposit bone grafting material into the tooth socket. That way, should you want to replace your tooth with a dental implant later on, that option will be available. View Example
- Dental Implants — In this optimal tooth-replacement system, a small titanium post embedded in the jawbone is attached to a highly realistic dental crown, permanently replacing the missing tooth. Implants require good bone volume and density to achieve their excellent functionality and high success rates. If you have already experienced bone loss, a graft can help regenerate enough bone to place the implant successfully.If a tooth is lost, a patient may seek dental implants to restore his/her smile. However, even dental implants need a healthy jawbone before they can be placed.
- Ridge Augmentation or Guided Bone Regeneration (GBR) is a bone graft procedure that restores the bone before the placement of implants by increasing the width of your jawbone or by filling in an extraction socket to prevent loss of bone during healing. Biocompatible membranes and bone grafts keep the tissue out, thus allowing the bone to grow.
- Sinus augmentation now makes it possible for many patients to have dental implants placed in the upper back area of the mouth. Years ago, there was no other option other than to wear loose fitting dentures. The sinus augmentation is a graft procedure that replaces bone between the bottom of the sinus cavity and the upper part of the jaw. When a back tooth is lost in the upper part of the jaw, the floor of the maxillary sinus drops down into the space that was occupied by the root of the missing tooth. For an implant to be placed in that space, the sinus floor must be pushed back up to where it was originally by adding a bone substitute to hold the sinus floor in place. After six months of healing, the bone substitute becomes part of the patient’s jaw and dental implants can then be inserted into the stabilized bone. View Example
What to Expect
The procedure for placing a bone graft usually requires only local anesthesia, though oral or IV (intravenous) sedatives can also be used to achieve a higher state of relaxation. Since a small incision is made in your gum tissue to gain access to the bone that will receive the graft, you may experience some soreness in the area after the surgery. This can usually be managed by over-the-counter anti-inflammatory medication and/or pain relievers, as well as ice therapy after the procedure. Any discomfort should only last a day or two. Then, over the next several months, your body will replace the graft with its own bone, reversing the decline in bone quantity you have experienced.
Post-surgical care Instructions for Ridge Augmentation
Rest with your head elevated when you arrive at home after the procedure. We ask that you please limit your physical activity and keep moving to a minimum for the first 24-hours.
For the first 4-5 hours after the surgery, we recommend placing an ice bag to your face in 20-minute intervals. This will help reduce facial swelling. If needed, you can use an ice bag for 24-hours. Your face will likely swell after surgery, so this is no cause for alarm. The ice and NSAID medication will both help alleviate the facial swelling.
Please take anti-inflammatory medications (NSAIDs) to prevent inflammation, swelling, and pain. For the next 4-5 days, we suggest taking 400mg-800mg of Ibuprofen every six hours to reduce swelling and pain and quicken healing. DO NOT take more than 2400mg in a 24-hour period. If you experience excessive pain or discomfort, take the narcotic that has been prescribed to you. If you do not have one, please call our office and the doctor will call in a prescription to your pharmacy. Please take as directed along with the NSAID. If you’ve been prescribed an antibiotic, please take as directed. We ask that you finish the entire dosage. If any of the medications are causing you extreme nausea, itching, or a rash; discontinue its use and call our office immediately.
If you had surgery on your sinus, we ask that you please take an antihistamine as directed on the box for the first 4-5 days, especially if you are prone to feeling “stuffy” or sneezing. Be careful, due to the fact that an antihistamine can make you sleepy.
Please take your prescribed antibiotic as directed. We ask that you finish the entire dosage. If you notice that your pain or swelling are only increasing, or that you have a fever, please call our office immediately. We will be able to tell you if you have an infection.
IF YOU EXPERIENCE BLEEDING
Some minor oozing is expected for a few days after surgery and is no cause for alarm. If you see a lot of “red” in your mouth, it is likely a mixture of a little blood with your saliva. Blood can strongly “dye” and will tint your saliva red. You are likely not bleeding nearly as much as it seems. To stop the bleeding, apply pressure on the surgical site with a moistened piece of gauze or a tea bag for 20 minutes. If your bleeding is moderate to heavy and has continued for a few hours without stopping, please call our office immediately.
Sometimes patients have nosebleeds after sinus augmentation surgery. If this happens, lie down with your head elevated and place an ice bag to your nasal area. If your nosebleed continues longer than 30 minutes and will not stop, please call our office immediately.
We ask that you do not try to eat until all the anesthesia has completely worn off. For the first week after surgery, we suggest eating high protein foods and liquids.
You may eat very soft foods if this can be done easily. Because your mouth will be sensitive, the food that you eat during the first week should be soft. Please DO NOT eat anything that is spicy, salty, acidic, very hot or very cold and please do not eat anything hard or crunchy, such as nuts, popcorn, chips, etc.
If possible, we also advise that you take the following nutritional supplements as they will aid in the healing process. Please take these vitamins for 4-6 weeks after surgery:
- Multi-vitamin with minerals (1/day)
- Calcium 500mg (twice/day)
- Vitamin E 400 iu (1/day)
- Vitamin C 1000mg (1/day)
CARING FOR YOUR MOUTH
We strongly request that you continue your regular oral hygiene habits on all other areas of your mouth. Please do not brush or floss the the surgical area during the first week after surgery as this will hinder the healing process. For the next month, please DO NOT use an irrigation tool, such as a WaterPik.
You can use an antiseptic mouthwash at least once in the morning and once at night before bed until your next appointment with our office. You can also gently swab the exposed surgical area with a cotton swab dipped in antiseptic mouthwash every morning, every night before bed and after eating and drinking.
WEARING YOUR REMOVABLE DENTAL APPLIANCE
If you have a removable appliance that replaces missing teeth and it touches your surgical area, please refrain from using this appliance as much as possible. We do not want any unneeded pressure on the surgical area as this could cause pain and hinder healing.
If you have any questions or concerns, please call our office at 847-658-3355.