BONE GRAFTS –

The technique of bone grafting has been practiced for over a hundred years. It’s a procedure that has many application including the enhancement of dental treatments

Many ask if a dental bone graft is required for their condition. When there are issues with your jawbone, your dentist might consider dental bone grafting. The procedure may sound involved, but in fact,  it can actually be a most beneficial path toward better dental health. As with any medical procedure, the more information you have about what to expect, the better the experience.

What Is a Bone Graft?

While still a surgical procedure, a dental bone graft is, in actuality, a relatively minor dental procedure. Dr. Goldenstein makes an incision to expose the bone of your jaw, then will graft new bone material to it. Your jaw bone generates new bone cells around the grafted material, building up strong bone where you need it.

Bone is actually a very malleable material. Your body makes new bone cells and replaces old ones on a regular basis. These changes are normal and a good thing for your body. Sometimes for one reason or another, you can end up without enough bone in your jaw for proper strength and a foundation, which might mean you need a bone graft.

When Do You Need a Dental Bone Graft?

If over time with age, or from an accident you’ve lost an adult tooth or had a gum disease, this presents a situation where you could benefit from a dental bone graft.

When your missing one of your adult teeth, the bone around your teeth starts to disappear. Gum disease could also cause your jaw bone to deteriorate and recede.

Any bone loss from just one tooth might not be noticeable or of major concern. But if you lose multiple teeth, or have advanced gum disease, your bone loss can actually affect the way your face looks. You may start to have sagging facial features because there’s not enough bone left to support them.

In addition to adding strength, bone grafts help to restore your appearance. It also aids in the placement of any tooth replacements you want or need.

Three Types of Dental Bone Grafting

There are different varieties of dental bone graft you might need to get.

1. The Socket Graft

The socket graft is the type of graft you usually receive at the same time as you get a tooth extracted. This prevents bone loss usually associated with adult tooth loss through any number of occurrences.

Your body won’t be able to reabsorb the bone near where the tooth was, because of the socket graft. This keeps your jaw ready for any dental implants you’ll choose to have to replace your missing tooth.

2. A Block Bone Graft

In this type of bone graft procedure, Dr. Goldenstein would use bone from the back of your jawbone, near one of your wisdom teeth. This is an excellent option if you have a more serious bone loss that needs to be treated.

3. A Sinus Lift Graft

Performed on your upper jaw, this bone graft is useful if you’ve lost some of the molars. Part of your sinus may actually start to expand downward, filling in the gap left by the missing teeth. Your sinus lift restores the sinus area to a more normal state while repairing the gap with a bone graft instead.

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The Bone Grafting Procedure

Bone Grafting Procedure

What can you expect if you and Dr. Goldenstein determined that a bone graft is beneficial to you? The procedure depends on why you need the procedure.

If the bone graft is recommended because it’s associated with a new dental implant, the first step is having the old tooth removed. Then, the bone graft will be done at the same time so that you’re ready for implant surgery later on. After the graft, you’ll have a stable base for your new tooth.

Most of the time, your bone graft is done with bone from your own body. It could come from the back of the jawbone, or from another body part.

However, many times, human or even animal donors are a good source of bone graft material. The bone material gets sanitized making it totally safe to use. Many people prefer this option because it requires a second surgical incision to get the bone.

Once the grafting is done, you’ll need to wait for a matter of several months before you can have your implant placed. It takes time for your bone to develop new bone around the graft, so the implant will be solid and stay in place.

Your bone graft surgery usually takes less than a couple of hours. It’ll be done in Dr. Goldenstein’s office under very strict supervision and using his vast experience. You’ll need a brief healing process that we’ll work with you to understand and manage.

The Graft Healing Process

The Bone Graft Healing Process

You’ll probably experience some pain after the bone graft is complete. However, the pain won’t be extreme. It can be managed with ice, and Dr. Goldenstein might also recommend medications to keep the swelling down. You’ll receive full instructions for any medication he prescribes.

An amount of swelling will be one of the most noticeable effects during your recovery. It’s important to reduce any swelling since it can hamper your healing process.

You’ll also need to have some awareness of what you eat while you’re recovering. Some procedures restrict you to a liquid diet, while others may allow a variation of soft foods. However, it will be a while before you can eat anything hard or crunchy such as meats, nuts, candy, or other tougher foods.

When sleeping, you may want to keep your head elevated, so blood doesn’t collect at the surgical site, thereby causing more swelling. And remember it’s important to avoid strenuous activity for a while so nothing harms the site of the graft.

Bone Graft Tissue Sources

Autograft

Autologous or autogenous bone grafting involves utilizing bone obtained from the same individual receiving the graft. Bone is harvested from nonessential bones, such as from iliac crest, mandibular symphysis (chin area), and anterior mandibular ramus (coronoid process).

When a block graft will be performed, autogenous bone is the most preferred because there is less risk of graft rejection as the graft originates from the patient′s own body. It would be osteoinductive and osteogenic, as well as osteoconductive. The disadvantage of autologous grafts is that additional surgical procedures are required, adding another potential location for postoperative pain and complications.

All bones require blood supply in the transplanted site. Depending on where the transplant site is and the size of the graft, an additional blood supply may be required. For these types of grafts, extraction of the part of the periosteum and accompanying blood vessels along with the donor bone is required. This kind of graft is known as a free flap graft.

Allografts

Allograft is derived from humans. The difference in this source is that allograft is harvested from an individual other than the one receiving the graft. Allograft bone is taken from donors that have donated their bone so that it can be used for living people who are in need of it; it is typically sourced from a bone bank.

There are three types of bone allograft available:

  • Fresh or fresh-frozen bone

  • FDBA

  • DFDBA

Allografts for bone repair often require sterilization and deactivation of proteins normally found in healthy bone. Contained in the extracellular matrix of bone tissue is the full cocktail of bone growth factors, proteins, and other bioactive materials necessary for osteoinduction and successful bone healing; the desired factors and proteins are removed from the mineralized tissue by using a demineralizing agent such as hydrochloric acid. The mineral content of the bone is degraded, and the osteoinductive agents remain in a demineralized bone matrix (DBM).

Synthetic Variants

Flexible hydrogel-hydroxyapatite (HA) composite which has a mineral to organic matrix ratio, approximating that of human bone.

Artificial bone can be created from ceramics such as calcium phosphates (e.g., HA and tricalcium phosphate), bioglass, and calcium sulfate are biologically active depending on solubility in the physiological environment.

These materials combine with growth factors, ions such as strontium or mixed with bone marrow aspirate to increase biological activity. The presence of elements such as strontium can result in higher bone mineral density (BMD) and enhanced osteoblast proliferation.

Xenograft

Xenografts are bone grafts from a species other than humans, such as bovine, and are used as a calcified matrix.

Alloplastic Grafts

Alloplastic grafts may be made from hydroxyapatite, a naturally occurring mineral (main mineral component of bone), made from bioactive glass. Hydroxyapatite is a synthetic bone graft, which is the most used now due to its osteoconduction, hardness, and acceptability by bone. Some synthetic bone grafts are made of calcium carbonate, which starts to decrease in usage because it is completely resorbable in a short time and makes the breaking of the bone easier. Finally used is the tricalcium phosphate in combination with hydroxyapatite and thus giving the effect of both, osteoconduction and resorbability.

Growth Factors

Growth factors enhanced grafts are produced using recombinant DNA technology. They consist of either human growth factors or morphogens (BMPs in conjunction with a carrier medium, such as collagen).

The factors and proteins that exist in bone are responsible for regulating cellular activity. Growth factors bind to receptors on cell surfaces and stimulate the intracellular environment to act. Generally, this activity translates to a protein kinase that induces a series of events resulting in transcription of messenger ribonucleic acid (mRNA) and ultimately into the formation of a protein to be used intracellularly or extracellularly. The combination and simultaneous activity of many factors results in controlled production and resorption of bone. These factors, residing in the extracellular matrix of bone, include TGF-beta, insulin-like growth factors I and II, PDGF, FGF, and BMPs.[,] Cell-based bone graft substitutes: Stem cells are cultured in the presence of various additives such as dexamethasone, ascorbic acid, and β-glycerophosphate to direct the undifferentiated cell towards osteoblast lineage.

The addition of TGF-beta and BMP-2, BMP-4, and BMP-7 to the culture media can also influence the stem cells towards osteogenic lineage. Mesenchymal stem cells have also been seeded onto bioactive ceramics conditioned to induce differentiation to osteoblasts.

Ceramic-Based Bone Graft Substitutes

The majority of bone grafts available involve ceramics, either alone or in combination with another material (e.g., calcium sulfate, bioactive glass, and calcium phosphate). The use of ceramics, like calcium phosphates, is calcium hydroxyapatite which is osteoconductive and osteointegration; and in some cases, osteoinductive. They require high temperatures for scaffold formation and have brittle properties.

  • Calcium sulfate is also known as plaster of Paris. It is biocompatible, bioactive, and resorbable after 30-60 days. Significant loss of its mechanical properties occurs upon its degradation; therefore, it is a questionable choice for load-bearing applications:

  • OsteoSet is a tablet used for defect packing. It is degraded in approximately 60 days.

  • Allomatrix is Osteoset combined with DBM, forms a putty or injectable paste. OsteoSet is a calcium sulfate tablet used for bone defect sites, whereas allomatrix is a combination of calcium sulfate and DBM that forms an injectable paste or fable putty.

Bioactive glass (bioglass) is a biologically active silicate-based glass,[] having high modulus and brittle nature; it has been used in combination with polymethylmethacrylate to form bioactive bone cement and with metal implants as a coating to form a calcium-deficient carbonated calcium phosphate layer which facilitates the chemical bonding of implants to the surrounding bone. Different types of calcium phosphates are tricalcium phosphate, synthetic hydroxyapatite, and coralline hydroxyapatite; available in pastes, putties, solid matrices, and granules.

Such calcium phosphates products include Bio-Oss and OsteoGraft. Both products use hydroxyapatite, either as a particulate (Bio-Oss) or as blocks and particulates (OsteoGraft). Pro-Osteon is a unique product based on sea coral, which is converted from calcium carbonate to calcium hydroxyapatite. The advantage of this material is that the structure of coral, which is similar to that of trabecular bone.

Polymer-Based Bone Graft Substitutes

This can be divided into natural polymers and synthetic polymers. Subclassified into degradable and nondegradable types. Polymer-based bone graft substitutes include the following:

  • Healos is a natural polymer-based product, a polymer-ceramic composite consisting of collagen fibers coated with hydroxyapatite and indicated for spinal fusions.

  • Cortoss is an injectable resin-based product with applications for load-bearing sites.

Degradable synthetic polymers, like natural polymers, are resorbed by the body. The benefit of having the implant resorbed by the body is that the body is able to heal itself completely without remaining foreign bodies.

INSTRUCTIONS:

Pre-Op preparation:

To aid in your surgery process and allow for maximum success and comfort, follow the instructions on the PDF sheet below.

You'll most likely receive post-surgery medication and will receive complete instructions. THIS IS A SAMPLE ONLY of the instructions you'll receive.

Open the above PDFs, download and read as appropriate.

 
Post-Op preparation:

To aid in your recovery and comfort, follow the instructions on the PDF sheet below.

Open the above PDF, download, and read as appropriate.

If you need a PDF Reader, you can download one here:

Bone grafts have become a normal and standard part of good oral health. It is done in those cases where age or accident has facilitated the loss of one or more teeth. This can include the removal of wisdom teeth or preparing for an upcoming dental implant. It adds strength to an otherwise weaked jaw location.

 

 

Your treatment may require anesthesia and you have several options that will be explained to you by Dr. Goldenstein.

It’s important to know that Oral, Facial, and Dental Implant surgeons are some of the most well educated and highly trained in the medical field. they study not only the general medical regimen of dentistry, but years studying their specialty and ancillary areas such as anesthesiology. This PDF might help to inform you of Dr. Goldenstein’s extensive training.

Oral and maxillofacial surgeons are extensively trained to administer local anesthesia, all forms of sedation, and general anesthesia in a safe and cost-effective manner in the office setting. They are required to obtain continuing education in anesthesia and to regularly undergo a rigorous office anesthesia evaluation and certification.