Patients should choose the most experienced practitioners to perform dental implant procedures and bone augmentations. A skilled, expert dentist boasting decades of experience and thousands of happy patients will give you peace of mind, knowing that you have chosen the best.
Before an implant is placed in a jaw, there must be enough bone to support it. If we liken this process to a building, its foundations must be properly planted in the ground in order for the building to stay up above the surface. The same applies to an implant, which must be well-anchored in bone to bear the prosthetic restoration above it.
Why can a bone deficiency occur?
In many cases, the main cause of bone deficiency is tooth loss. Where there is no tooth to support, the supporting bone is resorbed. Other causes are infectious processes such as periodontal disease (link to periodontal disease), trauma, tumors, etc.
What should be done in these cases?
To tell whether there is enough bone for inserting an implant, a CT scan must be done (internal link to digital images). This 3D imaging modality allows the practitioner to estimate the length and width of the bone in the position that is intended for implant placement.
If we identify a bone deficiency, bone grafting may be done either in a separate, preparatory surgery, or during the implant placement procedure itself, to ensure that there is enough bone to house the implants.
There are several bone grafting methods that are based on various augmentation materials. The source of bone for grafting may be autologous (i.e. taken from the patient himself and transferred to another position in the mouth). Another possible source is a xenogeneic graft (an animal source). This option is used most often. Other possible sources are from donors or from corals.
Another, new technique is using an extracted tooth, which is ground up and prepared in a special medium for use as a bone replacement, based on the understanding that the mineral composition of dentin and bone is similar.
Sometimes, bone is augmented as part of the implant placement process, and sometimes as a preliminary surgery.
The broader the bone augmentation, the longer the waiting time for the next stage, and it may take up to three to four months.
To increase the success of implantation and bone augmentation, we also use Platelet Rich Fibrin , which requires extracting blood, similar to a simple blood test. The blood test tubes are inserted into a centrifuge, which separates the red and the white lines of the blood. The white line received from the centrifuge contains all the body’s natural healing agents, such a platelets, white blood cells and other substances. We place this component in the extraction / implantation area, to speed up the recovery process.
Sinus Lifting / Sinus Augmentation:
When the bone deficiency is in the area of the upper molars, a preliminary surgical procedure called a sinus lifting is sometimes needed.
It should be emphasized that today, owing to advanced technology, the need for sinus lifting can sometimes be avoided by using short or tilted implants. If possible, we will avoid it, but if it is necessary, it is desirable to have the procedure done by the most experienced practitioners.
A brief anatomic explanation: what is a sinus?
The skull contains many air cavities called sinuses, but the ones of interest to us are the sinuses housed in the cheek area above the upper teeth. In other words, the ceiling of the mouth in the rear area is effectively beneath the sinus floor. If the ceiling of the mouth is too thin and we drive the implant through it, it will enter the sinus. Therefore, a sinus lifting procedure is required. In this procedure, we lift the inner lining membrane of the sinus and thicken the bone under it, leaving room to anchor the implant from within the mouth.
There are two options for sinus lifting:
- Closed sinus lifting – the access for thickening the bone is done through the extraction site. After the tooth has been extracted using special tools, the sinus floor is lifted and a bone substitute is inserted through the mouth. This is suitable for cases requiring a small to medium amount of bone augmentation.
- Open sinus lifting: the access to the sinus is performed directly through a side opening. This way, a medium to large bone augmentation may be done for the sinus floor.
Sometimes, implants are placed together with sinus lift, and sometimes the implantation process is deferred until enough bone has built up. In any case, immediate loading (link to implants) must be avoided and it is necessary to wait six to eight months until restorative loading of the new implants.