The Process of Bone Augmentation in Dental Implantology

Watch Dental Video about Bone Augmentation

How bone augmentation works in order to allow the insertion of dental implants.

If there is not enough bone available for dental implants, then bone augmentation surgery is able to recreate sufficient bone bedding. Many a time, after long-term tooth loss or focuses of inflammation, the diagnosis is “alveolar atrophy,” (i.e., the loss of the denture-supporting bone portion of the upper or lower jaw).

In most cases, successful insertion of dental implants in the remaining jaw bone is no longer possible because the nerves or paranasal sinuses would be affected. The solution is a bone augmentation, which can be performed with material from the patient’s own body or with external material. There are various bone replacement materials available. Below is a small overview.

A rough rule of thumb: The more the donor bone resembles human bone, the better the implant will adapt and heal. Therefore, one’s own bone heals the best, as long as the bone block does not exceed a certain size.

From a certain size on, it’s better to revert to cleaned donor bone. Either cleaned human bone is used – currently the best option – or animal bone, e.g., from bovines. Other bone replacement materials, such algae, can also be used. Synthetic bone requires the longest time to heal, although there is still intensive research going on in this area.

saggital Schnitt durch Kieferknochen Grafik des Oberkiefers

jaw bones reconstruction

The colonization of donor bone with your own cells is of no use whatsoever. It’s more efficient to mix the donor bone with your blood. In most cases, this should be quite sufficient. It usually works better during surgery. Whether it’s actually useful during the healing process is questionable.

Although there are a large number of professional studies dealing with these issues, most of them are badly structured with regard to content, and thus do not comply with the guidelines of evidence-based medicine. Furthermore, many of these bone augmentation materials are distributed by physicians themselves and thus everybody has his favorite; there is often little room for objectivity!

Foreign human bone material for bone augmentation?

Whatever bone replacement material we desire from an ethical viewpoint, it has to be said that biological material currently achieves far better end results than synthetic replacement material.

However, material from one’s own body is associated with additional surgical procedures, which is why people often revert to foreign material. Where do human bone products come from? Normally, human bone – or tissue in general – is obtained from corpses or as a side product of surgery (e.g., in case of femoral neck fractures).

Usually, the extraction of tissue and bone is strictly regulated and monitored by law. Thus, it is not possible, for example, to use material resulting from an individual’s surgery without the permission of the patient because – in strictly legal terms – it is the “property” of the patient.

With regard to the deceased, the legal situation varies from country to country. Many countries have their own donor registries, in which people must register themselves while alive in order to allow organs and tissue to be extracted after their death.

Implantatgewinde im Knochen

implant thread bone

Other countries go the opposite way: They have an objection registry, which means that as a matter of principle, organs and tissue may be extracted from any deceased person as long as that person did NOT register himself or herself in the objection registry while alive.

This policy may sound macabre to you, but it is evident that far more organs and tissue are available to save people’s lives through organ transplants and to alleviate diseases through tissue transplants through this kind of registry. By the way, such “extractions” can only be performed by government- registered and monitored institutions!

What happens if dental implants protrude into the maxillary sinus – without bone augmentation surgery?

Due to long-term toothlessness and/or periodontitis, there is often not enough jawbone available in the upper jaw. In such a case, a bone augmentation surgery, called a sinus lift, must be performed prior to the implantation.

Despite exact planning, implants might protrude into the maxillary sinus. The important thing is that you are informed about this possibility. Many patients get dental implants inserted and are unaware of the fact that the maxillary sinus was injured in the process.

The danger in such situations is that the implants could get infected due to a lack of protective bone layer if, for example, an infection of the paranasal sinuses should develop in the course of a trivial cold. This could then lead to the loss of the implant.

Click here to see the video: Augmentation

 

This post is also available in: German

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