Major & Minor Bone Grafting
Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and aesthetic appearance.
Major Bone Grafting
Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip or tibia (below the knee). Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patients own bone. This bone is harvested from a number of different sites depending on the size of the defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia), are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.
Bone Grafting Overview
For a brief narrated overview of the bone grafting process, please click the image below. It will launch our educational MiniModule in a separate window that may answer some of your questions about bone grafting.
Sinus Lift Procedure
The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.
There is a solution and its called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patients jaw and dental implants can be inserted and stabilized in this new sinus bone.
The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.
If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.
The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants in the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and second premolar, with the above-mentioned secondary condition. Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever), usually other, less aggressive options are considered first (placement of blade implants, etc.).
Typically, an outer section of the cheek side of the lower jawbone is removed in order to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area and slightly pull it out to the side. At the same time, we will place the implants. Then the bundle is released and placed back over the implants. The surgical access is refilled with bone graft material of the surgeons choice and the area is closed.
These procedures may be performed separately or together, depending upon the individual’s condition. As stated earlier, there are several areas of the body that are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region, or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. When we use the patients own bone for repairs, we generally get the best results.
In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to promote the patients own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.
These surgeries are performed in the out-office surgical suite under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.
MATTHEW M. KIKUCHI, DMD
Patient Review By Mandy L
Dr. Kikuchi is a world-class oral surgeon and bedside manner is his specialty. He treats each patient like they are the only patient. He spends quality time and ensures every question is given a well-reasoned and thoughtful answer. His staff is top-notch, not only are they efficient in handling the insurance company, but they are cheerful and caring. I don't think anyone wants to visit an oral surgeon, but in the event you have to, this is the best doctor in town!
- Mandy L
Patient Review By Chester G
I had never been to an oral surgeon, and I was extremely nervous, but Dr. Kikuchi and staff made me feel very comfortable during all aspects of my procedure. I would definitely recommend Dr. Kikuchi. I am actually looking forward to my next procedure in a few months knowing that I will be in excellent care.
- Chester G
Patient Review By Claudia Mares
Everyone was amazing! Thank you!
- Claudia Mares
Patient Review By Matt S
Dr. Kikuchi is great! Do recommend him for all Ortho needs. Friendly staff
- Matt S
Patient Review By Tammie S
The experience that I had was extremely comfortable. Every step of the procedure was explained to me. The staff from the front desk to the back is superbl Dr Kikuchi personally called and checked on me the evening of the procedure to see how I was doing. I will recommend Dr. Kikuchi and staff to every one I know. Thank you all.
- Tammie S
Patient Review By Ana M
Hello let me start off by saying I was very nervous about my treatment but Dr. Kikuchi and staff were all amazing and very professional very nice office, makes you feel like your at home very welcoming. I was very please with information given to me before and after my surgery! I woke up wondering when they were going to start, will be going back to finish my implant!!
- Ana M
Patient Review By Pamela T
The staff & Dr. Kikuchi made me calm & kept me comfortable in a situation that could have been very negative. Went in with LOTS of anxiety & they immediately turned it around. They didn't make me feel rushed thru any of the process. A big thank you to Becky for helping us get all the pieces of this put together & organized to make it all happen! A huge thank you for doing your jobs & running your office with such kindness & compassion while being very professional!
- Pamela T