Bone Grafting

Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, you may not be a candidate for implant placement without a bone graft.

For a brief narrated overview of the bone grafting process, please click the image on the right. It will launch our flash educational MiniModule in a separate window that may answer some of your questions about bone grafting.

Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore function and esthetic appearance.

Major Bone Grafting

Major bone grafts are typically performed to repair defects of the jaws. Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. Large defects are repaired using the patient’s own bone. The bone is usually taken from the jaw or hip. Occasionally we can use bone from a tissue bank. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.

Sinus Lift Procedure

Sinus bone grafts are also performed to replace bone in the posterior upper jaw. The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.

There is a solution and it’s called a sinus graft or sinus lift graft. Your oral surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.

The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.

If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation will have to be performed first, then the graft will have to mature for several months. Once the graft has matured, the implants can be placed.

Platelet Rich Plasma

Platelet Rich Plasma (PRP) is exactly what its name suggests. The substance is a by-product of blood (plasma) that is rich in platelets. Until now, its use has been confined to the hospital setting. This was due to the cost of separating the platelets from the blood (thousands) and the large amount of blood needed (one unit) to produce a suitable quantity of platelets. New technology permits the doctors at North County Oral & Facial Surgery Center to harvest and produce a sufficient quantity of platelets from only 25-55 cc of blood drawn from the patient while they are having outpatient surgery.

Why all the excitement about PRP? PRP permits the body to take advantage of the normal healing pathways at a greatly accelerated rate. During the healing process, the body rushes many cells and cell-types to the wound in order to initiate the healing process. One of those cell types is platelets. Platelets perform many functions, including formation of a blood clot and release of growth factors (GF) into the wound. These growth factors (platelet derived growth factors PGDF, transforming growth factor beta TGF, and insulin-like growth factor ILGF) function to assist the body in repairing itself by stimulating stem cells to regenerate new tissue. The more growth factors released into the wound, the more stem cells stimulated to produce new host tissue. PRP helps the body to heal faster and more efficiently in a natural way.

PRP has many clinical applications:

Bone grafting for dental implants. This includes onlay and inlay grafts, sinus lift procedures, ridge augmentation procedures, and closure of cleft, lip and palate defects.
Repair of bone defects created by removal of teeth or small cysts
Repair of fistulas between the sinus cavity and mouth

PRP also has many advantages:

Safety: PRP is a by-product of the patient’s own blood; therefore, disease transmission is not an issue.
Convenience: PRP can be generated in the surgery center while the patient is undergoing an outpatient surgical procedure, such as placement of dental implants.
Faster healing: The super-saturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and thus faster tissue regeneration.
Cost effectiveness: Since PRP harvesting is done with only 25-55 cc of blood, the patient need not incur the expense of the harvesting procedure in hospital or at the blood bank.
Ease of use: PRP is easy to handle and actually improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.

Frequently asked questions about PRP:

1. Is PRP safe?
Yes. During the outpatient surgical procedure a small amount of your own blood is drawn out via the IV. This blood is then placed in the PRP centrifuge machine and spun down. In less than fifteen minutes, the PRP is formed and ready to use.

2. Should PRP be used in all bone-grafting cases?
Not always. In some cases, there is no need for PRP. However, in the majority of cases, application of PRP to the graft will increase the final amount of bone present in addition to making the wound heal faster and more efficiently.

3. Will my insurance cover the costs?
Unfortunately not. The cost of the PRP application (approximately $400) is paid by the patient.

4. Can PRP be used alone to stimulate bone formation?
No. PRP must be mixed with either the patient’s own bone, a bone substitute material.

5. Are there any contraindications to PRP?
Very few. Obviously, patients with bleeding disorders or hematologic diseases do not qualify for this in-office procedure. Check with your surgeon and/or primary care physician to determine if PRP is right for you.