BONE GRAFTING FAQ
What is Grafting?
Grafting is a procedure used to replace / restore missing bone or gum tissue
A gum (gingival) graft is used to replace missing and / or receded gum tissue.
Types of gum tissue:
There are two types of gum tissue in the mouth, one of which surrounds the necks of the teeth and is thick and protective in nature (keratinized gingiva). The other of which lines our cheeks and floor of the mouth whose purpose is to be elastic and mobile in nature (mucosa).
Why is a gum graft needed?
Soft tissue grafts are used to replace missing thick tissue (keratinized gingiva), which has worn away from the necks of the teeth for a variety of reasons. The purpose of gum grafting is to minimize and/or arrest the progression of recession.
Unfortunately associated with every type of recession, there is bone loss, because the bone resides just beneath the gums. Therefore, if the gums have receded, then the bone too has receded. The purpose of gum grafting is to arrest the progression of recession and thereby halt the bone loss as well, by restoring a thick zone of protective tissue around the neck of the tooth / teeth which exhibits an absence of this thick keratinized gum tissue.
In certain instances it is not only possible to restore the missing keratinized (thick / protective) gum tissue, but also to cover the exposed root surface of the tooth / teeth in question. Other issues must be addressed as well, such as the biting forces being placed on the teeth.
Unbalanced forces placed on the teeth in the presence of clenching or grinding can predispose an individual to recession. Being a candidate for this root coverage procedure, which is achieved by a connective tissue graft, is to be determined by the individual practitioner.
Cosmetic Gum Grafts:
Esthetic gum grafting can be used to "plump up" the gum tissue in an area that is deficient and would result an unaesthetic cosmetic make-over. Remember the teeth and gums should exhibit symmetry, yet sometimes one side is deficient, therefore, gum grafting may be essential to achieve symmetry prior to a cosmetic make-over.
What causes recession?
1. Aggressive brushing - potentially? Some people believe that aggressive brushing with a hard bristled brush may be a co-factor in recession or erosion of the neck of the tooth
2. Excessive biting forces - clenching and/or grinding? This can result in bending / flexing of teeth, which will often result in fracture of a small portion of tooth structure at the gum line (abfractions) and consequently bone and gum recession
3. Maloccluded and misaligned teeth? Teeth that positioned outside the normal arch form of the jaw are subject to having abnormal forces placed on them causing recession
When treating recession by gum grafting, the causative factor must also be addressed in order for the grafting procedure to be successful.
What are the different types of Gum Grafts?
1. Soft tissue graft: There are many types of soft tissue grafts. This type of graft involves taking a small piece of tissue from the surface skin on the roof of the mouth and transplanting it to areas in the mouth that are lacking. This type of graft restores and augments the missing thick keratinized gingiva, but does not result in covering of the exposed root.
2. Connective Tissue Graft: In this procedure tissue is taken from the undersurface of the palatal tissue (roof of the mouth) via tiny incisions, and is used to not only restore missing thick keratinized gum tissue, but also used to cover exposed roots of the teeth.
What are the types of bone graft?
1. autogenous - bone taken from one area of the patient and transplanted to another area requiring such grafting
2. allograft - either synthetic bone or bone from a bone bank (cadaver bone)
3. xenograft - bovine /cow bone
Which graft is used and when and why?
Autogenous bone is the "gold standard" and oftentimes has the most predictable results. This is described as the best type of graft because such bone is live bone with live active cellular elements that enhance bone growth, whereas other types of grafts are devoid of any active cellular material.
Allografts and Xenografts both do not require a second surgical site as does the autogenous bone. Ample amounts can be easily obtained.
In conjunction with bone grafting, membranes are often used to help stabilize the bone graft as well as displace the gum tissue from invading the healing bone graft. Gum tissue grows at a much faster rate than bone, therefore, membranes are used to prevent gum tissue from growing in and displacing the bone graft before it matures.
How is the sinus lift procedure performed?
The sinus lift is a surgical procedure. The specific technique that the dentist utilizes can vary depending upon their training and experiences but traditionally the procedure has been performed as follows:
- The dentist will make an incision in the patient's gum tissue on the cheek side of their upper jaw in the area where the placement of the dental implant is planned (in the region originally occupied by the patient's bicuspid or molar teeth). This incision allows the dentist to flap back the patient's gum tissue and expose the jawbone that lies underneath.
- The exposed bone is cut in a fashion where a "trap door" of bone, hinged at the top, is created. This movable section of bone is then pushed gently inward and upward into the sinus cavity. This bone movement caries the sinus membrane attached to it with it, thus "lifting" the membrane (and hence the sinus floor) to a new, higher level. The empty space underneath the lifted sinus membrane is then packed with bone-graft material thus providing the new bone into which the tooth implant will be placed
- Once the bone-graft material has been positioned the gum tissue is stitched closed.
- In some instances it can be possible that the dentist will place the dental implant at the same time that the sinus lift is performed. In most cases, however, a dentist will allow a healing period of six to nine months before the dental implant is placed. The specific time frame allowed for healing is dependent upon the type of bone-graft material that has been utilized
What types of bone-graft materials are used with the sinus lift procedure?
Several different types of bone-graft materials can be utilized with the sinus lift procedure. In some instances the patient's own bone will be used, such as bone harvested from another location in the patient's mouth or else from other bones (including the hip (iliac crest) or shin bone (tibia)). In other instances prepared bone (frozen bone, freeze-dried bone, demineralized freeze-dried bone), either human or from another species (i.e. bovine), can be purchased from a tissue bank for use. Another alternative involves the use of synthetically derived graft material such as hydroxyapatite.
The procedure involves placement of a bone graft that may be obtained from the patients body or may be synthetic bone substitutes.The surgery lasts around 1-2 hours & may be carried out under Local / General anesthesia. Normal activity may be resumed from the third day onwards.
The entire procedure is carried out from inside the mouth & there is no visible scar on the face, nor does it alter the facial topography in any way.There are generally no attending post-operative complications if all the given instructions are followed.