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350 South Beverly Drive, Suite 160 (310) 553-2940

Bone Graft Dental

WHAT IS BONE GRAFTING

Bone Graft Dental – Over a period of time, the jawbone associated with missing teeth atrophies and 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, the patient is not a candidate for placement of dental implants.

 

With bone grafting, in addition to having the opportunity replace bone where it is missing, we also the ability to promote new bone growth in that location! This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.

Step 1

Failed tooth.

Step 2

Tooth is removed.

Step 3

Socket filled with bone grafting material.

Step 4

Natural bone and material have merged.

Step 5

Fully healed bone graft.

TYPES OF BONE GRAFTING MATERIAL

Autogenous Bone Autogenous bone grafts, also known as autografts, are made from your own bone, taken from somewhere else in the body. The bone is typically harvested from the chin, or the posterior lower jaw. Autogenous bone grafts are advantageous in that the graft material is live bone, meaning it contains living cellular elements that enhance bone growth. However, one downside to the autograft is that it requires a second procedure to harvest bone from elsewhere in the body. Depending on your condition, a second procedure may not be in your best interest. With advent of newer techniques these types of grafts are utilized less and less in our practice.

 

Allogenic Bone 

Allogenic bone, or allograft, is human bone from a tissue bank which is sterilzed and the processed for clincal use. Unlike autogenous bone, allogenic bone cannot induce new bone formation on its own. Rather, it serves as a framework or scaffold over which bone from the surrounding bony walls can grow to fill the defect or void.

 

Xenogenic Bone

Xenogenic bone is derived from non-living bone of another species, usually a cow. The bone is processed at very high temperatures to avoid the potential for immune rejection and contamination. Like allogenic grafts, xenogenic grafts serve as a framework for bone from the surrounding area to grow and fill the void.

 

Bone Graft Substitutes

As a substitute to using real bone, many synthetic materials are available as safe alternatives, including Calcium Sulfate, Hydroxy apatite, and beta tri calcium phosphate.  Although there are improvements in these materials they still do not work as well as autogenous, or allogenic bone.

 

Graft Composites

Graft composites consist of other bone graft materials and growth factors to achieve the benefits of a variety of substances. Some combinations may include: collagen/ceramic composite, which closely resembles the composition of natural bone, DBM combined with bone marrow cells, which aid in the growth of new bone, or a collagen/ceramic/autograft composite.

 

Bone Morphogenetic Proteins:

Bone morphogenic protein is an isolated protein that induces specific cells in our body to form new cartilage and bone. During surgery, the BMP is soaked onto and binds with a collagen sponge. The sponge is then designed to resorb, or disappear, over time. As the sponge dissolves, the bone morphogenic protein stimulates the cells to produce new bone. The BMP also goes away once it has completed its task of jump starting the normal bone healing process. Since there is no need to harvest bone from the patients’ hip for BMP, recipients are spared donor site pain. Complications from the graft harvest site are also eliminated with the use of bone morphogenic protein.

 

Dr. Madison would be happy to discuss all grafting options with you at the time of consultation.

Common Types of Bone Graft Procedures

SOCKET BONE GRAFT

Bone grafts are often required after a tooth removal. This type of bone graft is called a “socket graft.”  When a tooth is removed, there is a void in the jaw bone called an extraction socket. The socket naturally fills with bone over time. But exactly how much bone one ends up with is very unpredictable. In most cases the bone is inadequate to support a dental implant. That is why it is essential to do a socket bone graft after most extractions. There are several factors that determine the success of a socket graft.

 

First and foremost the tooth has to be removed with utmost skill so that the surrounding one is not damaged.  This technique is called traumatic tooth extraction, which is essentially a very a gentle tooth extraction technique that removes the tooth without damage to the surrounding bone. Once the tooth is removed, the socket needs to be cleaned of all infections. Then the proper graft material needs to be packed into the socket.

 

The choice of the graft material is also essential in the success of the bone graft. There are great many “bone graft” materials available but only a select few have been proven to grow bone consistently. Once the graft is placed it needs adequate healing time to turn into solid bone. This healing period is usually from 3 to 6 months.

SINUS LIFT

A procedure that is also referred to as “sinus lift”, “sinus graft” or “sinus augmentation”, is a commonly used method for growing bone in upper jaw (maxilla) in the area of the posterior premolar and molar teeth. The maxillary sinuses are hollow cavities that occupy the back of the upper jaw above the posterior teeth. Often the roots of the upper jaw penetrate into the maxillary sinus when they are present. When these teeth are lost or removed, the bone that is left behind is usually inadequate to support dental implants. The method that is used to grow bone in this area is very technique sensitive, and should only be attempted by highly trained dental surgeons.  General dentists do not have adequate training to handle these types of procedures. 

Preparation:

 

A thorough review of your health history and the health of your sinuses are first undertaken. Then a 3 dimensional (CT) scan and possibly a panoramic X-ray are taken to carefully study the anatomy of the upper jaw and sinuses. Once this information is analyzed a treatment plan is developed, and the right approach for your specific case is recommended.

 

There are two general techniques for sinus grafting:

 

Lateral Window Sinus Lift

 

The entire procedure is all done from the inside of the patient’s mouth. A small flap is elevated to expose the upper jaw, and then a window is made into the sinus. The sinus is covered by a very thin membrane. This membrane is carefully elevated away, and bone graft material is packed into the newly created space. The bone graft material can be allogenic (bottled bone from tissue banks, that are specifically processed for dental use), or autogenous (harvested from the patient.) In some instances we use synthetic material, or Infuse Bone Graft®, a special and effective form of bone growth protein. The bone usually requires six months of healing before it becomes solid enough to support dental implants.

 

Internal Sinus Lift

 

This procedure is usually done at the same time as dental implant placement.  The technique involves carefully lifting the sinus membrane though a small channel that is prepared in the jaw bone at the dental implant recipient site.  Then bone graft material is gently packed into the area and the dental implant is then placed.

RIDGE AUGMENTATION

Dental ridge augmentation is a bone grafting technique that refers to re-growing  a damaged jaw bone so that it can accept a dental implant.  In order to place a successful dental implant the jaw bone needs to be of adequate volume and consistency.  If the tooth has been missing for a long time, or the bone was lost as a result of an infection or trauma, then the bone volume is usually inadequate for supporting a dental implant.

 

Various techniques are utilized for regenerating bone in a deficient ridge.  The selection of the techniques depends on multiple factors, such as the area of the mouth and the volume of the bone that needs regeneration.

 

Some of the more common techniques are:

 

Onlay graft or Block graft – The bony defect can be regenerated by using a small block of bone that is secured with small fixation screw into the area of deficiency. The bone block can either be bone from tissue banks that are specifically processed for this purpose or harvested from another part of the patient’s jaw.

 

Guided bone regeneration – The jaw defect is re-grown using bone and a specialized membrane. Once the graft is placed it needs 4 – 6 months of healing before an implant can be placed.

 

Ridge splitting – If the jaw ridge has a narrow width, then it can be split and expanded at the time of implant placement.

 

Infuse Bone Graft or BMP – The human bone contains a protein called human bone morphogenetic protein-2. This protein is naturally secreted by the body to regulate bone growth and healing. This protein has been isolated and genetically engineered in the laboratory and is now available to naturally grow bone.

 

As an alternative to the traditional method of using bone chips or blocks harvested from healthy bone elsewhere in the body , this new method requires implanting the BMPs via a carrier collagen membrane, directly onto the bone. The BMP is released slowly over time stimulating the bone to grow. This process often can take anywhere form 4 to 9 months, depending on the size of the defect.

This method is very technique sensitive, but the results can be spectacular. It is now it is now possible to grow bone in compromised cases where previous bone grafting techniques were not as successful.

 

 

Happy Patients

  • Dr. Madison is the best!
    Jacky L. from Los Angeles, CA
  • Dr. Madison came highly recommended and did not disappoint. Everything was done professionally and efficiently with a minimum of time and discomfort. Also, his office is phenomenal, state of the art. This was actually easier than getting my teeth cleaned.
    Nonie H. from Santa Monica, CA
  • Fantastic staff. Dr. Madison is a calm and skilled pro.
    Randy Carolyn C. from Los Angeles, CANicklson . ATC resident manager co.
  • I am thrilled that Dr. Madison was able to save my tooth!
    Janice B. from Encino
  • Never even took Tylenol.
    Judy W. from Beverly Hills, CA

Wonderful Testimonials

  • I am very pleased with the entire experience from start to finish.
    Dylan M. from Los Angeles, CA
  • Dr. Madison was always very informative and gentle with every procedue. He really took the time to get me well again!
    Rachel W. from Burbank, CA
  • Beautiful office, friendly staff and gentle dentist. What's not to love?
    Edith E. from Beverly Hills, CA
  • Quick, painless and my implants look great! Did I mention painless! The staff is friendly and professional.
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  • Great "Chair-side manner," no pain and amazing results!!! What else could you ask for?
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