Additional Surgery with Dental Implants

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You may have heard people talking about surgery that is required before you are able to have dental implants fitted. Not everyone will need this, but there are some surgical bone grafting procedures to increase the amount of bone available to implant into. Your dentist will discuss these with you if you do not have enough bone, but the type of surgery used and the determination of what is too little bone will differ from dentist to dentist.

Bone grafting

This is a procedure that can increase bone depth or thickness as well as height and width. The bone must be thick enough in every direction to support the stress placed by the implant’s root shape when the patient is chewing. Dentists like to be able to implant the titanium into the jaw bone at a depth which is equal to the height that the crown will be above the bone. This is the 1:1 crown to root ratio. Less of a ratio than this means that the implant will not be as permanent, and only a short implant can be fitted. If it is less than this bone can be grafted or replaced. The bone can be taken from elsewhere on the patient’s body, for example the hip, and this is called an autograft. Other bone can be used, for example an allograft is where the bone comes from cadavers; a xenograft is where the bone is bovine, and there are bone-like substances which have been manufactured to have similar properties, usually calcium sulphate.

The procedure for a bone graft requires local anaesthetic. The surgeon will lift the gum to expose the jawbone where the graft is needed, and the additional bone is grafted on. An infection-repelling mucous membrane is then placed over the bone and the gum is stitched back up. You may be given a course of antibiotics as well as the antiseptic mouth washes used to heal from implant surgery. The healing can take several months. When your mouth is healed, further x-rays or C scans may be used to may sure that the height and width of the bone is now sufficient.

The bone that is grafted on produces vascular bone and, therefore, is alive – so it is very similar to your natural jaw bone. This makes it suitable for receiving dental implants.

Sinus Lifting

Sinus lifting is a common type of bone graft procedure used to increase the volume of bone (and therefore the quality of bone) for the implants to be placed into. It is sometimes referred to as a bilateral lift – meaning that there are two surgical procedures. The first is to actually lift the sinus and the second is the placement of the titanium dental implant.

Sinus lifting is fairly common if your bone is thinner. Problems are likely in this area because the upper jaw usually has a thinner bone density than the lower jaw which means there is more chance that you will not be able to hold an implant. Just above the upper jaw are the sinuses which are in fact pockets of air – so if the bone is not thick enough the implant will literally be placed into air.

A dentist, periodontist, prosthodontist or oral surgeon can carry out the procedure with proper training. Your dentist may refer you to a dental hospital, or he may be able to perform the surgery himself. With the help of either bone transplantation or the use of a bone expletive substance the part of the bone that is too thin is thickened (in the direction of the sinus, hence the procedure name). The need for this surgery can often be detected by using a 3d x-ray, and your dentist can perform in advance of you’re your implant surgery date.

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