In what cases may the bone fail to take root?
The bone may not take root in cases where it becomes infected, including when the patient violated the schedule for taking antibiotics or did not follow the doctor’s orders.
Much attention is paid to food intake: the patient can simply, out of forgetfulness, bite into something hard, and his stitches will come apart, and the material and bone graft will become infected through the open wound.
The above accounts for 90 percent of cases
when the bone may not take root.
Are there any contraindications to bone grafting?
Of course, there are contraindications to bone grafting. These include
:
- various chronic diseases, incl. diabetes mellitus with high sugar levels,
- the period when the patient takes a number of drugs, including chemotherapy,
- in the period after chemotherapy, when the bone cannot be “touched” at all.
Features of hygiene after bone grafting
After bone grafting it is recommended
:
- use of special surgical toothbrushes,
- the use of toothpaste should be limited, and even better, use special toothpastes for post-surgical interventions,
The main thing when carrying out hygiene is NOT TO INJURY
area of bone grafting! You should try to eliminate contact with this area or reduce it to a minimum.
When can you do without bone grafting?
You can always do without bone grafting when you can install an implant of the required diameter and required length into the remaining bone.
And, in fact, you shouldn’t do bone grafting just to assert yourself. Some doctors suffer from this, trying to prove to themselves or someone else how they can do bone grafting.
But, as they say, the best bone grafting is the one we don’t do: if the patient can be rehabilitated without bone grafting, then it’s better to do just that. Since volume can be added with soft tissues, connective tissue can be transplanted - a graft, or drugs can be added to replace the volume of soft tissues - and achieve an excellent result!
Causes of bone deficiency:
1) The main reason for the decrease in bone tissue volume is the natural atrophy (resorption) of bone, which occurs in the area of extracted teeth. This happens because the bone loses support in view of the tooth root, and also because in the absence of the tooth root, chewing pressure ceases to be exerted on the bone tissue. As a consequence, there is a decrease in bone volume, which can occur both in height and in width of the alveolar process of the jaw.
2) The second reason is the traumatic removal of decayed teeth by dental surgeons. Usually, during removal, the surgeon does not think at all about the safety of the bone walls of the alveoli around the tooth, biting them off with forceps. If you are planning extraction followed by tooth implantation, then it is best to carry out such removal by an implant surgeon, who will try to preserve the bone tissue as much as possible.
There are 3 types of bone resorption –
- horizontal resorption (Fig. 2), when the width of the alveolar process decreases,
- vertical resorption (Fig. 3), i.e. when there is a decrease in the height of the alveolar process,
- + combined form.
According to the type of resorption in a particular patient, a bone grafting technique is selected, aimed at increasing the width and/or height of the alveolar process of the jaw.
What implants are used after bone grafting?
Are there “special implants” that are recommended in cases of bone grafting? Both with bone grafting and without bone grafting, it is necessary to use implants only from good, proven manufacturers, those that have a good clinical base. For example – Straumann, Nobel, Ankylos, Xive, Astra Tech.
There are a number of other implant systems that give good results. But at the German Implant Center we use only the best implant systems, only premium ones.
How is implantation performed during bone grafting?
Implantation during bone grafting can be carried out either simultaneously with bone grafting, or delayed - when the implants are installed in the new “grown” bone.
As an experienced implant surgeon, in my practice, in 80-90 percent of cases I perform bone grafting at the same time
with implantation.
I will explain why I perform plastic surgery with implantation at the same time, and what is the advantage of this approach. Bone grafting itself requires a long healing period, from 4 to 9 months. And if we maintain this period and then do implantation, then we have to wait another 4 months. That is, the time frame in this case increases significantly.
And if I do implantation along with bone grafting, then the implant takes root along with the bone. A good implant has an excellent osteogenerating surface, and when fused, an excellent result
.
This reduces the patient’s rehabilitation time. And most importantly, the patient DOES NOT NEED
second surgery. We understand that a large number of surgical interventions do not improve trophism, mucous membranes, or bone tissue.
Everything we do at the German Implant Center, from tooth extraction to implantation, is carried out as atraumatically as possible for the patient.
How many implants are placed during a total restoration?
We specialize very broadly in total implant rehabilitation. In the upper jaw, 6-8 implants are recommended according to our protocol; in the lower jaw, 6 implants are sufficient for total rehabilitation.
Often, implantation occurs simultaneously with the installation of temporary teeth, that is, the patient leaves the clinic “with teeth”, and not on the second or third day, but on the same day when implantation is done:
Preliminary implantation planning is carried out using CBCT, the implants are placed in the required positions.
After this, a surgical template is made, according to which the implants are installed. And based on the same computed tomography (CBCT) and images, a temporary structure is made that will be attached to the implants installed for the patient.
And it turns out the so-called “full case” is when the patient comes, if necessary, if circumstances require it, teeth are removed (or they have already been removed/lost earlier), implants are placed on the patient and an orthopedic structure is fixed - his new teeth.
Indications
The gums may recede when:
- no load;
- periodontal diseases;
- tissue detachment;
- defects caused by injuries.
By tightly adhering to the artificial tooth, soft tissues solve several problems:
- Form an aesthetic gum margin
- Protects the bone tissue around the implant from infection
- Prevents plaque from accumulating in gum pockets
Gum augmentation during implantation can be carried out during the installation of the implant or after its engraftment. It depends on what problem the soft tissue transplantation solves.
On which jaw does tooth bone resorption occur faster?
How quickly does a deficiency of bone and bone tissue occur in the absence of a tooth?
In fact, tooth bone tissue decreases faster in the upper jaw, since the upper jaw is softer and more porous. In the lower jaw, the bone also disappears quite quickly, since the vestibular plate near the teeth is quite thin. Six months after tooth loss, quite severe atrophy of bone tissue occurs, and the atrophy progresses. And therefore, in order to avoid atrophy, it is advisable to do implantation simultaneously immediately after tooth extraction.
This format is the regular, daily work of the specialists of the German Implantology Center. For example, a patient comes with a crack in the root of a tooth - the tooth must be removed. We can go with two options:
Option 1.
We can remove the tooth and 3 months later implant the tooth into the patient.
But during these three months, shrinkage of the bone tissue still occurs, since - I said earlier - the vestibular bone plate is very thin. And in this case, the patient undergoes 2 surgical interventions
: the first is tooth extraction, the second surgical intervention is the installation of a dental implant.
Option 2.
In our practice, we recommend and practice the second option. This is a one-step implantation, when the patient has a tooth removed, an implant is installed, and in order to avoid collapse of the bone tissue in the places where the roots of the tooth used to be, these places are filled with a bone graft. Due to graft filling, we do not have tissue “collapse”; the contour of both the gums and the jaw bone tissue is preserved. Which, in turn, is very difficult to achieve with delayed, delayed implantation.
Who can undergo bone grafting?
Who are potential patients for bone grafting, and what are the age restrictions for it?
This is a bit of a tricky question :). The oldest patient I have performed bone grafting on is a 75-year-old patient, a wonderful, purposeful woman. She had bilateral terminal defects on her lower jaw. She really wanted implantation and refused a removable structure.
I performed bone grafting on this woman at the same time as implantation. And literally 6 months later she was fitted with prosthetics. And everything went great.
In the case of the patient’s age, the main thing is that he has no contraindications. Perhaps there are age restrictions, but they are not so pronounced, because, although trophism deteriorates with age, regenerative abilities decrease, but the main thing is the presence of contraindications. You need to look at the tests, and if the patient is healthy at 75 years old, then why not?
Gumplasty: what is the procedure and when is it performed?
Gingivoplasty is a microsurgical operation. It is performed under local anesthesia. This operation is performed to improve the aesthetics of a smile, since a smile is considered beautiful in which healthy, straight teeth and gums are visible, the so-called harmony between pink (gingival) and white (dental) aesthetics. There are medical indications for gingivoplasty:
- uneven gum contour;
- “gummy” smile;
- gum recession;
- prevention of tooth root caries;
- prevention of the development of periodontal diseases;
- improvement of tissue structure;
- treatment of gingivitis, periodontitis;
- ingrowth of cheek tissue into the gum;
- exposure of the tooth root;
- lack of gum volume around the existing implant;
- implant installation.
Gum recession clinical case
Gingivoplasty is necessary to eliminate soft tissue defects in the root and neck areas of teeth. The operation is performed either after flap surgery or on gums that have not previously undergone any procedures.
Gum recession
How to do without bone grafting
Is it possible to do without bone grafting and sinus lift?
Yes, in some cases you can do without bone grafting. But you need to understand that if the patient does not have bone tissue, and we install an implant, the crown will hang over the gum, and something from food will constantly get clogged there. That is, it is aesthetically unsightly, and all the food will be stuffed there, the patient will always have a “pocket of food supplies” from yesterday and the day before yesterday.
Option with a smaller diameter implant
You can place an implant of a smaller diameter, and at the same time we can carry out soft tissue regeneration - replant the mucous membrane (this can be connective tissue from the palate, from the tubercle of the upper jaw). And thus we achieve replenishment of the volume of soft tissues. Due to this, aesthetics are visually improved and hygiene problems are eliminated.
Whenever it is possible to avoid various surgical procedures, but not at the expense of quality, then they should be avoided.
That is, surgery for the sake of surgery - it is not needed
.
Postoperative recovery
After gingivoplasty, the doctor will tell you what needs to be done during the period of soft tissue restoration. Healing lasts from several days to 2-3 weeks. During the postoperative period, patients at our clinic are recommended to:
- take painkillers as prescribed by your doctor;
- reduce physical activity;
- eat warm crushed food;
- exclude spicy foods from the diet;
- rinse the mouth with an antiseptic solution;
- Do not use a toothbrush to clean the suture site.
After the procedure, the swelling lasts up to 5 days, then it begins to subside. If the swelling does not disappear, or complications arise, you should immediately consult a doctor.
To correct a smile using soft tissue, gingivoplasty is the optimal procedure. It is absolutely safe, but there are risks, as with any surgical procedure.
This could be an allergic reaction to the anesthesia (which is extremely rare when using modern anesthetics) or a recurrence of gum recession. In case of relapse, re-treatment is carried out after six months. To avoid this, immediately inform your dentist about any existing diseases.
