Bone Grafting

Major & Minor 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, most patients are not candidates for placement of dental implants.

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 functionality and aesthetic appearance.

Major Bone Grafting

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee). Sinus bone grafts are also performed to replace bone in the posterior upper jaw. 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.

Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patients own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.

Sinus Lift Procedure

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 its called a sinus graft or sinus lift graft. The dental implant 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 patients 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, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.

Ridge Expansion

In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.

Nerve Repositioning

The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants in the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and second premolar, with the above-mentioned secondary condition. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever), usually other, less aggressive options are considered first (placement of blade implants, etc.).

Typically, an outer section of the cheek side of the lower jawbone is removed in order to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area and slightly pull it out to the side. At the same time, we will place the implants. Then the bundle is released and placed back over the implants. The surgical access is refilled with bone graft material of the surgeons choice and the area is closed.

These procedures may be performed separately or together, depending upon the individual’s condition. As stated earlier, there are several areas of the body that are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region, or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. When we use the patients own bone for repairs, we generally get the best results.

In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to promote the patients own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.

These surgeries are performed in the out-office surgical suite under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.

Sam B. Hishmeh, DDS, PA - Oral & Maxillofacial Surgery

5 out of 5 stars based on 116 Bone Grafting reviews

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I have never been in more capable hands as I was with Dr. Hishmeh. I have been seen by him many times and NOT once has he left me ill informed, or in needless pain.

- Gary S

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The experience was very good. The office staff is well organized and prepared for my visit. The doctor and his assistant were pleasant, precise, and did a great job explaining the procedure. The actual procedure took less time than I expected, I was surprised at how early I was on my way back home. I would recommend this office for anyone in need of the services they offer.

- Randy G

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Dr. Hishmeh and his staff were amazing! I am terrified of dental work and everyone in the office was so kind and put even me at ease. I had a fractured tooth under a crown causing alot off pain. The procedure was quick and painless. I could not be happier with the results. The service I received was top notch, and the level of caring and compassion are off the charts. I highly recommend their services.

- christine t

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It's not often you can say that you had a great experience at the dentist's office, but I did today with Dr. Hishmeh. I was faced with a difficult extraction of a damaged tooth, but Dr. Hishmeh explained the procedure thoroughly before we started and put my mind at ease. The procedure went very smoothly and i had very little discomfort - I'm looking forward to my next appointment and a new implant.

- Brian B

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Appreciated the care provided.

- Freddie A

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It was a pleasant experience given it was a dental office visit. The collective personality and efficiency displayed by Dr. Hishmeh and supporting staff was exceptional and, moreover, much appreciated.

- Sump R

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Very nice experience for an elderly patient.

- Wilma R

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The staff and the doctor all displayed a high degree of knowledge and caring. Great sense of humor, immediately made me at ease

- Jacob C

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Dr. Hishmeh made himself available for me with very little notice. He has a sense of humor and put me at ease. Best of all, he and his staff were very professional and most importantly, very competent. As a health professional myself, I highly recommend Dr. Hishmeh.

- Maryanne M

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Somewhat of an emergency visit and staff was very good about calling me with a cancellation time so I could get in sooner. There was a little bit of a wait beyond my scheduled appointment time but it really wasn't an issue.

- Robert F

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All were very prophessional and made me less stressed. I would recommend them to my friends.

- Pat D

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I strongly recommend this practice to anyone that requires any kind of oral care. My extraction took less than five minutes. I felt no pain during the procedure and very minimal discomfort after the extraction. AWESOME JOB

- William D

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They well done . They wonderful team and smart Doctor

- Amany B

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The staff were professional, knowledgeable, and efficient. Dr. Hishmeh was great - I had two teeth removed and didn't feel a thing. I was in and out in under 30 minutes. Dental work is never fun, but Dr. Hishmeh and his staff were wonderful to work with. I would absolutely return if I required further services.

- Danielle W

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Staff was outstanding and Dr. Sam is the best! Didn't feel a thing! Will be back for future work if needed. Highly Recommend.....

- Greg W

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In and out in less than 40 minutes for a tooth extraction

- ADAM L

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The physician, office staff, and all aspects of our experience have been a 5 out of 5. Dr. Sam and his staff are adults, they care, they are knowledgeable, they listen, they care, and they respond. We will be sure to do all of our oral needs with them and will be sure to let our dentists know to refer their patients here as well. Thank you for being such a great service to your clients and for bringing adults with experience to the office.

- David M

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I would highly recommend to anyone Dr.Sam Hishmeh and staff for dental service.

- James

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Had an Evaluation one day in Silver Spring and an extraction the following day in Clarksville. With the current pandemic, both facilities met all recommendations. The staff is personable, professional and efficient. Dr. Hishmeh was the Best. He explained each step of my procedure and what to expect which made me very comfortable. The procedure was quick and far better than anticipated.

- Nancy H

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Best staff--wonderful doctor-- No pain during extraction of 6 teeth!

- Susn T

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