In many circumstances, the area where patients are interested in having dental implants are lacking the necessary bone to stabilize it. The bone may be insufficient in height and/or in width. A number of procedures exist to help rebuild the necessary bone, so that implant therapy may be utilized.
The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty bowls with a lining on the bottom. 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. The goal of the procedure is to lift the lining (also called a "membrane") up so that more bone can be>developed in the area to support an implant.
Dr. Cohen typically enters the area from where the upper teeth used to be. The sinus membrane is then lifted upward and bone graft material 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 patient's 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. This offers vast improvements over dentures that may become loose over time and make talking and chewing difficult.
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 and the implants placed after a delayed period of time (usually 6-9 months).
Over a period of time, the jawbone associated with missing teeth atrophies or is resorbed. This often leaves a condition in which there are poor quality and quantity of bone for cosmetic tooth replacement.
In patients opting for treatments involving dental implants, sufficient bone height and width is necessary for stabilization and complete bone encompassment of the implant.
Patients whose treatment includes the use of "Crowns" and "Bridges" also need sufficient bone and gum tissue present so that the new dental work appears natural. Proper ratios of the amount of gum and tooth showing are critical for ideal smile design. Many times in this situation, the appearance of the full bone and gum tissue is all that is needed to make the cosmetic dentistry appear natural.
Today, in many situations, we have the ability to grow bone and tissue where needed. This not only gives us the opportunity to place implants of proper length and width or "Bridges" with proper tissue ratios, but it also gives us a chance to restore functionality and esthetic appearance.
We have a number of ways to redevelop bone and tissue height and width to meet cosmetic and functional demands. Although it is impossible to guarantee
the exact amount of bone or tissue an individual's body will develop, these procedures predictably achieve the desired effects.
The development of increased bone width can be achieved via Guided Bone Regeneration and Ridge Expansion (Splitting).
Guided Bone Regeneration is achieved by adding additional layers of bone material on the existing bone with the intention of guiding the body to develop its own bone in those locations. Once anesthesia is achieved, bone graft material is added to the designated sites of treatment. Typically, a membrane ("Barrier") is placed over the graft material to aid in its stabilization.
The graft material used is typically in the form of a powder or solid block. There are synthetic and donor tissues available. In some circumstances, patients may opt to utilize their own donor bone from other sites in their mouth. Dr. Cohen can review with you the options most suitable for you. In some cases, dental implants can be placed at the time of augmentation. Often, a 6-9 month period of bone development is first needed prior to implant placement.
Ridge Expansion (Splitting) is another method of widening bone without the need for graft material. In some cases (varies per patient), certain areas of bone can actually be expanded due to its spongy or elastic capabilities. In many cases, dental implants can be placed at the time of ridge expansion. Both of these types of procedures may take more than an hour to complete. Patients may experience some swelling and bruising due to the nature of the procedures.
The development of the appearance of full bone and tissue can also be achieved with Soft Tissue Ridge Augmentation. The goal is to thicken the areas requiring treatment, so they appear fuller. Soft Tissue Augmentation typically utilizes either transplanted thick tissue from the palate or donor tissue. This tissue is then placed between the existing gum and bone to "plump" up the area. This procedure is similar to the one described in the Gingival Grafts section.
It is important to understand that these procedures were developed to help you regain tissues your body has already lost. In essence, we are creating human tissue. With that I mind, there is no way to guarantee your body will regenerate new tissue. It is also important to realize that certain medical considerations such as smoking and diabetes (along with a host of others) play a major role in success as well. Some patients are poor candidates for these treatment options. Dr. Cohen will review all conditions pertinent to you when discussing any of these procedures.