Bone Grafting

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Doctors tell me that not replacing my missing tooth can have negative effects on my jawbone? How is that?
What is bone grafting?
What is a sinus lift procedure?
I am considering having implants to replace my lower back teeth but I was told that I don’t have enough bone to anchor an implant. Is there really no way to get rid of my partial?
I am missing an upper front tooth but I was told my bone is too thin to receive an implant. Is the conventional bridge the only option for me?
Can my bone graft be rejected?

Doctors tell me that not replacing my missing tooth can have negative effects on my jawbone? How is that?

The teeth and jawbone are in a close-knit relationship. Both coexist if they stick together!

Have you ever noticed infant jaws somehow resemble that of an edentulous, elderly person?  Although they are different sizes, their shape is essentially the same. When compared to that of an adult with a normal set of teeth, both are greatly reduced in volume and made of basal bone only.

When teeth erupt, they haul up a big chunk of newly-formed bone from the basal jawbone. To give an idea of what it’s like, think of the formation of a mole hill

with the tooth standing in the center. This horseshoe-shaped bony structure that runs the entire length of both the maxillary and mandibular dental arches, and in which tooth roots are embedded, is called the alveolar ridge. It is very unique in that it only exists for the sake of the teeth that it retains.

When chewing and swallowing, teeth transmit, through compressive and tensile forces, the stimulation the alveolar bone critically needs to remain dense and thick. “Form ever follows function”, as the old saying goes.

Alternatively, when you lose a tooth, the lack of stimulation to its supporting bone causes a decrease in height, width, and density. In the first year after it has been taken out, there is already 25% shrinkage in bone volume, and this process continues into the years to come.

If you know that you are going to lose a tooth, do not hesitate to schedule an appointment since there are certain procedures that can prevent or limit the amount of resorption.

To learn more about teeth and facial aesthetics, please read our page on dental facelift.

What is bone grafting?

This is a surgical procedure that involves transplanting bone mass into an area of your jaw that misses it.

The advent of dental implant ushered in a new era for dental prosthetics. They are titanium posts that are surgically inserted into your jaw. As such, they are replacement roots. These posts restore the stimulation to your jawbone, something no traditional tooth replacement option can do, let alone removable dentures. Along with chewing capacity, stimulation to the bone is restored.

Your body starts sending essential nutrients to your jaw once again, preventing new bone loss from occurring.

Think of implant placement in the same way as if you were hanging a 25 pound antic mirror onto drywall. You’d better use a good length screw-in anchor, and make sure your wall is thick enough to accommodate it!

If your jawbone has withered too much following tooth loss, it may not be bulky enough to properly support dental implants. Even placing implants that are too short can significantly impact the success of the treatment, leading to failure. In most cases, bone volume needs to be at least 5mm in width, and 6 to 10mm in height to safely insert an implant.

Just because your bone is too narrow does not mean you cannot receive dental implants. Rather, you will need a bone graft first. Bone grafting materials act as a scaffold for bone regeneration. As healing proceeds, your newly-formed bone fuses to the graft particles, restoring strength, and allowing your body to replace the graft material with its own bone over time.

According to your particular situation, implant placement and bone graft can be done at the same time. If not, then it is prudent to wait a few months before the insertion of implants.

Your own bone can be used as grafting material. Donor sites are the chin and wisdom tooth area of the lower jaw. Or, as is often the case now, we can use a particulate bone material of bovine origin whose stringent requirements in the production process ensure the highest security in terms of immunity and contamination.  This type of bone grafting is done routinely all over the world with great success.

In some instances, Dr. Gaumet may also use growth factors which are proteins inducing bone formation.

What is a sinus lift procedure?

Many of our facial bones contain air-filled cavities, called sinuses. One of their roles may be that they make our skull lighter. Maxillary sinuses are located below the cheekbone and the eye, next to the nose, above the palate, and to the inside of the cheek. Think of it as a miniature cliff dwelling, or a tiny cave, with its ceiling,  walls, and its floor sitting right above the roof of your mouth and your back teeth roots. It is lined by a membrane whose texture resembles that of a thick and dense spider web. Sinusitis, in fact, refers to an inflammation of that membrane.

Remember, once teeth are lost, the alveolar bone supporting them begins to vanish, absorbed back into the body. If you have been missing upper back teeth for a long time, it is very likely that you do not have enough bone height left between basal bone crest (right beneath the gum), and the floor of your sinus. Perhaps not more than 2 to 5mm left…And herein lies the problem: you cannot anchor the dental implant into the air! You critically need then to have the floor of this air-filled sinus “lifted” to get this 12mm of bone to secure implants. That is what this procedure aims at!

The surgery is carried out from inside the mouth in the area just above the missing back teeth. A small opening is created in the cheek-side bony wall of the sinus to get direct access to the membrane which is then “elevated” from the floor. The graft material is placed on the floor and under the membrane.

This procedure is associated with moderate swelling and some discomfort generally lasting for a few days to a week. Supportive treatment is usually recommended for routine sinus surgeries including a course of antibiotics to prevent infection and a non-steroidal anti-inflammatory medication to minimize discomfort and prevent swelling.

I am considering having implants to replace my lower back teeth but I was told that I don’t have enough bone to anchor an implant. Is there really no way to get rid of my partial?

Yes, there are. Don’t worry!  But we’ll need to grow some bone.

Unlike the maxilla, there is a nerve running through a canal in your lower jaw; therein lies the issue: it must be left untouched, or you risk facing sensory disturbances. Accordingly, the bone mass fully available for implant placement is located right above this nerve. It may not be more than 3 to 5mm in height if you have been without lower back teeth for some time, even less so if you have been fitted with a removable denture. Remember, you need at least 6 to 8 mm in this area to put implants.

There are now two revolutionary procedures available to increase ridge dimension in this area. Vertical ridge augmentation can be obtained with the “sandwich technique”. The bone located above the nerve is freed from the rest of the jaw and gently elevated. The gap created is then filled with the particulate bone graft.

The other way to proceed is to use the “tent pole technique”: tiny titanium posts are placed in your withered bone ridge to hold up a thin membrane. The particulate bone graft is placed underneath. Implants can sometimes act as tentpoles. It cut the need for a second surgery.

These so-called guided bone regeneration techniques have become predictable thanks to advances in material sciences.

Back teeth provide facial height and cheek support. When you get back your molars, you feel rejuvenated through chewing capability and smiling. Your look, health, quality of life improve, all of which boosts your self-confidence and self-esteem.

When performing these grafts as well as sinus lifts, Dr. Gaumet may ask you whether you are willing to have a little bit of your blood drawn out. It is mixed with the bone graft. Blood contains a multitude of growth factors that speed up healing and improve bone regeneration.

This a new approach to tissue regeneration. You may have heard about it. This is called PRF (platelet-rich-fibrin) and is also used in the treatment of traumatic arthritis.

I am missing an upper front tooth but I was told my bone is too thin to receive an implant. Is the conventional bridge the only option for me?

Not at all. You definitely can get an implant but we’ll need to bulk your bone ridge up.

As is often the case, these sites do not require vertical ridge augmentation, and the residual ridge is usually between 3 and 5 mm in width (horizontally). The favored technique in this situation is the ridge expansion. A series of instruments in the like of bone chisels are used to split the bone crest into two plates- one on the tongue side, the other on the lip side- which are then delicately pushed away from each other. In this process, a bed for the implant is created with condensed bone all around. Since no burs or drills are used, loss of bone associated with drilling is prevented. When both plates of bone are sufficiently apart, the implant and the bone graft are sandwiched in between. This a technique sensitive procedure that does not entail much trauma.


No, not in any way.

Graft rejection is caused by the immune system identifying the transplanted tissue as foreign, triggering a response that will ultimately destroy the transplanted organ. This immune response is triggered by the presence of the donor’s own antigens lining the surface of the cells. Once the bone graft has been harvested from the donor, it goes through a lengthy process of purification whereby immunogens are eliminated. Bone grafts do not harbor cells anymore. Rejection just cannot happen.

The only thing that might happen is a wrong surgical technique, or an infection.

If you have been disappointed in the past because you’ve been told that you have insufficient bone and that your only option was a bridge or a removable prosthesis, do not hesitate to meet with Dr. Gaumet. Your individual situation will be properly assessed and your implant treatment plan will be laid out for you.

Contact Us for an Appointment Today

To schedule an appointment, please call us at 41 21 323-7564.

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