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Oral & Maxillofacial Surgery

Bone Grafting

What Is 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. With bone grafting, we now have the opportunity to not only replace bone where it is missing, but also the ability to promote new bone growth in that location. 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. 

What Can Bone Grafting Accomplish?

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. 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. 

How is Bone Grafting Accomplished?

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. Large defects are repaired using the patient’s 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.

What Types of Bone Grafts are Available?

Autogenous bone grafts, also known as autografts, are made from your own bone, taken from somewhere else in the body. The bone is typically harvested from the chin, jaw, lower leg bone, hip, or the skull. Autogenous bone grafts are advantageous in that the graft material is live bone, meaning it contains living cellular elements that enhance bone growth. However, one downside to the autograft is that it requires a second procedure to harvest bone from elsewhere in the body. Allogenic bone, or allograft, is dead bone harvested from a cadaver, then processed using a freeze-dry method to extract the water via a vacuum. Unlike autogenous bone, allogenic bone cannot produce new bone on its own. Rather, it serves as a framework or scaffold over which bone from the surrounding bony walls can grow to fill the defect or void. Xenogenic bone is derived from non-living bone of another species, usually a cow. The bone is processed at very high temperatures to avoid the potential for immune rejection and contamination. Like allogenic grafts, xenogenic grafts serve as a framework for bone from the surrounding area to grow and fill the void.

Both allogenic and xenogenic bone grafting are advantageous in that they do not require a second procedure to harvest your own bone, as with autografts. However, because these options lack autograft’s bone-forming properties, bone regeneration may take longer than with autografts, with a less predictable outcome.

Are There Other Options?

As a substitute to using real bone, many synthetic materials are available as a safe and proven alternative, including: demineralized bone matrix (DBM)/demineralized freeze-dried bone allograft (DFDBA), graft composites (collagen/ceramic composite, DBM with bone marrow cells, or collagen/ceramic/autograft composite), and/or bone morphogenetic protein (BMP) a commonly used protein naturally produced in the body that promotes and regulates bone formation and healing. Synthetic materials also have the advantage of not requiring a second procedure to harvest bone, reducing risk and pain. 

Each bone grafting option has its own risks and benefits. Our surgeons at WK Oral and Maxillofacial Surgery Institute will determine which type of bone graft material is right for you.