Bone Grafting

Bone Grafting: Major and Minor

Among the most prominent long-term effects of tooth loss is jawbone resorption, or the gradual deterioration of the jaw due to the missing tooth root or roots. In such cases, there may not be enough high-quality jawbone for an implant placement procedure. In the past this rendered such patients unable to receive these highly beneficial dental implants.

With the emergence of bone-grafting technology, however, patients suffering from jawbone resorption can benefit from implants. Grafting not only allows implant placement, but helps to restore the bone to its original cosmetic appearance and strength.


Major Bone Grafting Procedures

Whether your jawbone structure has suffered due to extractions, trauma, or gum disease, bone grafting can make dental implants an option again. In a bone grafting procedure, the bone is acquired from your own bone material (such as from the tibia, hip, or other parts of the jaw) or via a tissue bank. In some cases a process called guided bone regeneration may be involved, in which special dissolvable membranes are used to promote bone regeneration and protect the graft. This process is also known as guided tissue generation. Most major bone grafting surgeries are done in an operating room and necessitate a hospital stay.


Why Jawbone Health is Important

When a tooth or a number of teeth are missing, jawbone deterioration can occur. While this can create serious cosmetic issues, there are also ways in which bone loss impacts health. Pain and discomfort, damage or loss of remaining teeth, and difficulty eating and speaking can all arise.

Bone tissue is maintained by regular use, and natural teeth help to create this stimulation through biting and chewing. When there is no longer a natural anchor– i.e. the tooth’s root– present, the lack of stimulation causes jawbone resorption.

The Possible Results of Jawbone Deterioration

  • Change to appearance and deterioration of overall facial structure (such as a collapsed facial profile)
  • Issues with remaining teeth such as loss and alignment problems
  • Wrinkling of skin in the mouth area
  • Lack of proper lip support
  • Expansion of the sinus
  • TMJ disorders, headaches, and pain and discomfort
  • Issues with speech and communication
  • Inability to eat properly due to pain and difficulty chewing


Causes of Jawbone Loss

A bone grafting procedure may be necessary in cases of jawbone loss, which is caused most often by these issues:

Tooth Extraction
Tooth extraction without proper replacement can cause jawbone loss, as natural teeth stimulate the jawbone through daily use. The portion of the jaw that anchors the teeth into the mouth is known as the alveolar bone, and when this lack of stimulation occurs, the body begins to break down or “resorb” the jawbone in that area.

How quickly and to what extent bone loss occurs is different for everyone, but the first eighteen months after a tooth extraction pose the most risk, after which deterioration will continue slowly over time.

Periodontal Diseases
Gum infections, or periodontal diseases, slowly erode your teeth’s natural support. A periodontal disease can affect any number of the periodontal tissues, which consist of the periodontal ligament, alveolar bone, gingiva, and cementum. There are numerous diseases that can affect the structure of your natural teeth’s support, but inflammatory lesions caused by buildup of plaque are the most common. These gum infections are separated into two main categories called gingivitis and periodontitis. Cases of gingivitis may not develop into periodontitis, but all periodontitis cases begin as gingivitis.

Gingivitis is most often caused by the buildup of dental plaque, especially in those who are genetically susceptible to this buildup. A colorless and sticky-feeling film, plague is predominantly made up of food particles and bacteria which adhere to your teeth. This can occur both at and below the gum line, and plaque is constantly forming. The bacteria in plaque can irritate the gums causing inflammation, swelling, redness, and bleeding. When this occurs for an extended period of time, the gums start to separate from the teeth and plaque hardens into calculus, more commonly known as tartar, which can also occur at or below the gum line.

The bacteria stuck to the teeth’s surface as well as the aggressive immune system response is what can cause periodontitis, the more serious of the two diseases. Should gingivitis develop into periodontitis, the bone and gum tissue supporting your teeth deteriorates and leads to progressive alveolar bone loss. This bone loss then leads to issues such as tooth loosening and eventual tooth loss.

Bridgework and Dentures
While unanchored dentures provide some cosmetic and functionality benefits, they do not stimulate the alveolar bone, leading to jawbone resorption – and because traditional dentures require sufficient bone to remain in place, loosening of the dentures and subsequent problems caused by this loosening often occurs. In some cases bone loss becomes so extensive that a new denture is necessary. In all cases, appropriate denture care and maintenance is necessary for optimal oral health.

Some dentures, such as bar-attachment dentures, are supported by implanted anchors that stimulate and preserve the jawbone.

In the case of bridgework, the supporting teeth on each side of the device continue to stimulate the jaw, but the gap where the teeth remain missing is still liable to jawbone resorption.

Thanks to advancements in bone grafting technology, the consequences of poor denture care can be treated and bone health can be recovered.

Injury & Trauma
Jawbone loss can stem from a tooth that has been knocked out or broken extensively. This deterioration can happen as a result of jaw fractures, injuries to the teeth – or patients with a history of trauma, as teeth may still die and cause bone loss even years after the patient was injured.

In cases of bone deterioration due to trauma, bone grafting can help your jaw return to its original functionality as well as promote necessary bone growth.

Alignment Issues
One of the major issues created by misalignment is a lack of opposing tooth structure, meaning that certain teeth may over-erupt and leave the jawbone improperly stimulated.

Other alignment problems such as normal wear-and-tear, lack of necessary treatment, and TMJ disorders can lead to issues with your teeth’s capacity to function normally. Because trouble with biting and chewing can occur, bone loss becomes a risk.

Osteomyelitis (Infection of the Jawbone)
The jawbone and accompanying marrow can become bacterially infected, leading to a condition known as osteomyelitis.Reduced blood supply can occur as a result of the inflammation osteomyelitis causes. While antibiotics are typically required, it may also be necessary to remove the infected bone. In these cases, grafting can be necessary to restore jaw health and function.
Growths & Tumors
Though benign facial tumors may not pose an immediate threat, they may still grow significantly and necessitate removing part of the jaw as a treatment method. Conversely, malignant mouth tumors will nearly always spread to the jaw. Whether a tumor is benign or malignant when the affected area of the jawbone is removed, a grafting procedure is typically needed to maintain jawbone functionality and health. Malignant tumors can pose greater difficulties, as cancer treatment often means also removing much of the soft tissues surrounding the bone.
Developmental Issues
In the case of certain syndromes and conditions, parts of the jaw, skull, teeth, and other facial bone structures may be missing. Grafting surgery can help to correct these absences.
Enlarged Sinus
Molar extraction can lead to bone resorption due to air pressure in the maxillary sinus. This in turn can result in a hyperpneumatized sinus, or an enlarged sinus.

A hyperpneumatized sinus develops over a course of multiple years, and can make implant placement difficult due to the reduced quantity of bone. However, a bone grafting surgery known as a “sinus” lift can treat this condition.

If you’re dealing with jawbone deterioration, call us now to learn about how bone grafting may be able to help you.

To learn more about the other procedures we offer for jawbone health, click here.