Bone Grafting and Sinus Lift
In the past, patients who had been missing a tooth for a long time or had suffered jawbone loss were not candidates for dental implants. Thankfully, advancements in the field of dentistry followed closely by Dr. Singer have changed this. Through bone grafting, sinus lifts, and an exciting implantable growth factor called BMP-2, (bone morphogenic protein) most patients can now be candidates for implants.
During this oral surgery procedure, Dr. Singer uses various bone grafting materials to supplement your existing jaw structure. These materials may include donor bone or bone harvested from another part of your body, such as the chin or posterior lower jaw. Donor bone can be sourced from human donors, bovine, equine, porcine or synthetic materials (beta-tricalcium phosphate). All forms are rigorously prepared through intensive processes to ensure safe use and have been approved by the FDA. Similar techniques and materials were used and continue to be used by orthopedic surgeons.
Ninety-nine percent of oral bone grafting procedures can be done with donor bone. This reduces morbidity to the patient by reducing the number of surgical sites, and the result is comparable, if not superior, to using their own bone.
As the bone graft heals, the grafted material is slowly replaced by your own new bone over a period of months, creating a solid foundation for a dental implant. Through various bone augmentation procedures, Dr. Singers implant placement becomes a viable option for almost all patients. The waiting time between bone graft and implant placement can range from immediate placement to a waiting period of 6 months depending on the situation.
In most cases, a local anesthetic and IV sedation or oral sedation can be used for the procedure. After a cone beam CT scan to obtain a 3D image of the bone, Dr. Singer can then see how much donor bone is required. Based on the type of defect that is now fully appreciated, Dr. Singer can review grafting options for the specific needs of a patient. Bone grafts can be thought of as very much customized based on patient wants and requirements.
As mentioned above, 99% of bone grafting can be performed with donor bone. In the case of an allograft (from the same species), Xenograft (bovine or equine) or synthetic (beta-tricalcium phosphate), the site is prepared, and the graft material is placed where bone is needed. After proper anesthesia, an incision is made to expose the underlying bone and create a space for the new bone under the gum tissues. The graft material is placed in the defect area to be augmented and is then typically covered with a membrane. The object of the membrane is to contain the graft particles and prevent ingrowth of the soft tissues (e.g., gum tissues). The gum incision is closed with sutures.
In the case of an autograft, an incision is then made at the bone graft donor site inside the mouth from the chin or jaw area. The needed amount of bone is then harvested along with the bone marrow. After the bone is placed at the recipient site, small temporary screws are used to hold the bone graft in place during the healing process. The incisions at both the donor and recipient sites are closed with sutures.
During the healing process, we will give you medication for pain and to prevent infection, and we will provide you with temporary dietary restrictions. You can expect some swelling and bleeding after the surgery for a short time.
After the graft has fused and before the implant is placed, the screws will be removed.
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The maxillary sinuses are located just above the upper posterior teeth. If the thickness of bone from the ridge of the upper jaw to the floor of the sinus is insufficient, dental implant posts can poke through into the sinus cavity. To remedy this risk, Dr. Singer performs a surgical procedure called a sinus lift (sometimes called sinus augmentation or sinus elevation).
The need for a sinus lift usually occurs because one or more of the back teeth are missing, causing bone loss over time. Bone loss can also sometimes happen as a result of periodontal disease as well.
A sinus lift entails using a Caldwell Luc approach to the sinus and gently lifting the membrane from the floor of the sinus. After the membrane is carefully lifted, bone grafts (usually donor) are placed into the sinus cavity floor to increase the height of the upper jaw. During the process of healing from the procedure, the newly added bone integrates with the sinus floor, allowing enough thickness for the placement of dental implants. Often, dental implants can be placed at the same time as the sinus lift procedure.
For sinus lifts, Dr. Singer typically uses a mix of bovine and allograft material, as in scientific literature, this has been shown to have the best results. The recipient site is specific in this case in order to augment the bone of the sinuses. The healing process and the amount of time required before the implants can be placed remain the same as well.
In the case of a sinus lift, however, you must refrain from blowing your nose and try to avoid sneezing during the healing process. For this reason, it is best not to schedule a sinus lift at the same time as seasonal allergies. You will be given a saline spray to use in your nostrils to keep the area moist as you heal.
Bone Morphogenic Protein (BMP-2)
This newer implant dentistry procedure is a miracle of modern science. It provides Dr. Singer with the ability to grow new bone with less invasive surgery. He uses this technique whenever possible, although some bone graft material is still required for most patients.
BMP-2 is an FDA-approved protein manufactured by the biotech firm Medtronic with the ability to regenerate bone tissue. It is a natural growth factor that helps attract stem cells to an area. It helps patients avoid bone loss after tooth removal, as well as regrow bone for implant placement. Because BMP-2 eliminates the need for grafts of bone tissue harvested from the chin, jaw, or other area of the body, patients experience less pain and dramatically shorter healing times.
A small incision must be made to deliver a collagen sponge into the recipient site. The sponge melts over time, and the BMP jump starts cell growth, naturally producing new bone.
This amazing dental procedure provides benefits beyond traditional grafting therapies, including the growth of the body’s own bone, predictability, and fewer surgeries.