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
Our Latest Patient Testimonials
being a super hyper personality the Dr did anexcelent job calming me down and pulling my tooth.....THANK YOU <<ALL RON
- Ron V
Our Latest Patient Testimonials
Dr. Hishmeh and his team were very thorough during my initial consultation and took the time answer all of my questions. Surgery day was fantastic, and recovery has been very smooth. Dr. Hishmeh is a great doctor with a fun sense of humor, and his team is friendly and attentive.
- Anna K
Our Latest Patient Testimonials
Very friendly, professional and efficient. Follows up on patients after surgery. Have had appointments in both offices with equal efficiency, at least some of the staff is the same in both offices. Three sets of wisdom teeth removed from three teenagers, will plan to go there again with the fourth.
- Elisa G
Our Latest Patient Testimonials
Excellent service
- Fatima D
Our Latest Patient Testimonials
Great Dr and staff.
- Angela P
Our Latest Patient Testimonials
Had a pleasant experience here, everyone is so nice 🙂
- Ana L
Our Latest Patient Testimonials
Great place,great people
- Doris W
Our Latest Patient Testimonials
Would highly recommend!
- Mary Jo H
Our Latest Patient Testimonials
Excellent dentist! Very pleased with the care 🙂
- Dani S
Our Latest Patient Testimonials
Doctor was very friendly and spent time to answer patient's questions.
- Victoria F
Our Latest Patient Testimonials
Best results!
- Mark R
Our Latest Patient Testimonials
Dr. Hishmeh is polite and friendly. He described my procedure using language that was easy for me to understand. The follow-up phone call from the office after my procedure was nice.
- Jenna L
Our Latest Patient Testimonials
A very nice dental office
- Anthony F
Our Latest Patient Testimonials
Quick and easy
- Sohha A
Our Latest Patient Testimonials
Good experience
- Cheryl W
Our Latest Patient Testimonials
Very easy painless procedure.
- Gail h H
Our Latest Patient Testimonials
Fantastic
- Mark peuser W
Our Latest Patient Testimonials
The staff was wonderful to work with and the doctor was open, friendly, and informative. Right before the procedure, my daughter had a mild health issue and the staff and doctor were extremely responsive and made sure it would be safe to proceed with wisdom tooth removal. My daughter had a quick and easy recovery. I would highly recommend this practice to anyone.
- Andrea T
Our Latest Patient Testimonials
Good bedside manners
- Robert C
Our Latest Patient Testimonials
We were nervous in the beginning but Dr. Hishmeh assured us that everything would be just fine. Better than we expected. He also has a good sense of humor which lightens things up! I'd recommend him to anyone.
- Monchae S