Bone Graft For Dental Implants
You may be contemplating having dental implant treatment done, or you may even be having it soon and the dentist or the implantologist may have suggested that you will need to have a bone graft in conjunction with the treatment. So the question you should be asking is, do I need to have a bone graft and, you know, why do I need to have a bone graft?
The bone graft will add substantially to the cost of the overall treatment, and it can also lengthen the treatment, not to mention that complications can arise from having a bone graft done which can actually ultimately caused the implant to not succeed.
Relationship of bone grafting and implants
In order to understand the relationship of bone grafting and implants, we’re going to look at a simple model of a healthy tooth. So imagine a block of plasticine, and imagine a Lego brick with the Lego brick held vertically, you press it halfway into the plasticine so that represents a tooth. The bit that you can see is the bit of the tooth that you can see in the mouth, the other half which is inside the plasticine which represents the root of a tooth which you cannot see because it’s covered by the bone and the gum, the plasticine represents the jawbone so the tooth is held tight by the jawbone.
Now imagine your tooth is being taken out, so imagine lifting the Lego brick out of the plasticine and you end up with a hole there. Immediately after you lose a tooth the blood clot fills into that hole or that gap, over the next few weeks and months that space where the blood clot is at the moment will eventually form into new bone, there is however a big however, and that is that new bone or the amount of new bone, will never ever be the same amount as the original bone that you have lost as a result of having the tooth out.
In many cases that doesn’t matter, because the remaining bone is or should be enough so that you can place a dental implant. The dental implant must be surrounded by bone all the way around so you can’t have a situation where there isn’t enough bone and that and you cannot have not enough bone in one of two ways. Firstly the width might not be enough, so that the implant is too wide for the socket and therefore the implant cannot be placed because there won’t be bone all the way around. Secondly, there may not be enough board height so although the implant can go in there won’t be enough bone to cover all of the implant.
When to have an implant
When you first have a tooth out, the other crucial element to this is that over a period of time forever you will continue to lose bone from that side where there is no tooth. This will continue for the rest of your life, at first the amount of bone you lose is quite fast but over a later time it does slow down but it never totally stops that’s the reason why if you need to have an implant done its best to have an implant almost as soon as you can after you have lost a tooth even better still you can have an implant at the same time as when a tooth is taken out. This is called an immediate implant, and an immediate implant therefore gives you the most chance to preserve the maximum amount of bone.
For an implant where it’s not all is possible to do an immediate implant, for example if there’s infection there you have to wait for it. This process of where the bone is being lost is called bone reabsorbtion, and it’s a term that your dentist may use. Now certain factors will increase your likelihood of needing a bone graft, a bone graft is something that a dentist can place to replace or add on to your existing bone in order to make the implant fully embedded within bone. Obviously a bone graft is a separate procedure so sometimes it can also be carried out at the same time as when the implant is actually placed itself, it all depends on the clinical situation.
So let’s look at factors which increase the need or increase the likelihood of needing a bone graft. We’ve said already that when you lose a tooth the process of bone reabsorbtion starts, so the sooner you can have an implant done after a tooth extraction generally the better it is because you are reducing the chances of more bone being lost.
Most teeth are extracted due to gum disease, and when you get gum disease you know that your teeth become loose and you become long in the tooth the reason for that is – going back to the plasticine and Lego model – is that in gum disease the bone, or the plasticine around the brick, starts to disappear and that’s why a tooth will become loose and that’s why you looked long in the tooth as well. If you know you have got gum disease therefore, you should try to minimize the gum disease so you do not lose any more bone, or if it is going to be a fact that you are going to lose your teeth, it is therefore better not to delay that process where the gum disease destroys all of the bone. If the gum disease does destroy all of the bone then it can make it difficult or even impossible to have any bone grafting done.
The third common scenario where a bone graft is needed, is where a tooth is infected where a tooth is infected because for example of an abscess, then the infection surrounding the teeth causes bone reabsorbtion – it actually destroys the bone around the teeth, so if you’ve got an infected tooth is better to have this treated or to have the tooth taken out in order to prevent unnecessary bone being lost.
So we’ve spoken about what happens to the bone around the teeth once a tooth is lost, and we’ve also spoken about factors that increase the bone loss around a tooth once it is lost and how to minimize this in another talk we’ll mention about the different types of bone graft and what can go wrong and alternatives.