Bone Grafting: Treatment and Materials

Is the Bone Graft Taken From my Own Bone?

At the Marylebone Implant Centre, we rarely harvest bone from the patient.

In the past, the gold standard material for bone grafting procedures was the patient’s own (autogenous) bone. Considering it has the same genetic code as the recipient site, these bone grafts tend to heal very quickly. Surgeons have traditionally used bone taken from the rib or skull of the patient.

More recently, bone harvested from the chin or ramus of the jawbone became more popular. Though in the last decade, these block graft techniques have become almost obsolete with the finding of issues related to this technique, such as extensive bone resorption (bone shrinkage). Therefore, bone harvested from the patient works very well in the initial stages, though can endanger the implants in the long-term.

Besides the poor stability over time, utilising autogenous bone involves a second surgical location which is can cause unnecessary discomfort for patients.

Is the Bone Graft Performed Prior to the Implant Placement?

In instances when there is insufficient bone in the proposed implant area, a bone graft may have to be performed prior to placement. The bone usually takes between 6-9 months to mature, after which placement can occur. This process isn’t the most common, however.

More often than not, implantologists are able to perform the bone graft and implant placement at the same time. The advantage of undertaking these procedures simultaneously is not only the reduction of total treatment time; the implantologist will have more control of biomaterial placement in relation to implant position. Simultaneous procedures generally occur when between 10-40% of horizontal bone is missing. All cases require individual evaluation, and during consultation, patients will have explained to them the implantologist’s recommended sequence of treatment.

Bone Grafting Techniques We Use

The most common bone graft technique used by our implantologists is called ‘Guided Bone Regeneration’. This technique, documented and tested for many decades by researchers, enables bone recreation by utilising a bone graft material – usually Bio-Oss, which is placed in the area of the bone defect where we intend to place our implants.

Covering the bone graft material, we use a collagen membrane, usually Bio-Gide from Geistlich. This holds the bone graft material in position and will guide the patient’s native bone cells to the grafted area, encouraging new bone formation. Over time, the bone graft material will change from a particulate to rock-solid consistency, eventually engulfed by the patient’s own bone.

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Sinus Lift

Each patient’s situation is different, though if an upper molar is missing or has been extracted, severe bone resorption can occur. Our experienced clinicians can rectify the resulting complications by performing a sinus lift procedure.

A sinus lift, also known as a maxillary sinus floor augmentation, is a procedure to increase bone volume in a patient’s upper jaw. This is deemed necessary by Dr. Santos when there is insufficient bone to support implant placement near the maxillary sinus.

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Block Grafting

When a patient doesn’t have sufficient bone structure to have implants set in place, the implantologist may decide on a block grafting procedure. In this instance, the bone would most likely be moved from the lower jawbone.

The graft will be secured using two small screws, and overlaid with collagen membrane and xenographic materials. There is usually a 4-6 month waiting period to ensure the treatment area is ready for implant placement.

Nowadays, this technique is rarely performed as we have other less invasive techniques available that provide a more successful long-term outcome.

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Guided Bone Regeneration

The GBR is a classic bone graft technique, widely researched and published, whereby utilizing a granulated grafting material (Bio-Oss) in combination with a collagen membrane (Bio-Gide), the implantologist is able to repair a bone defect.

This is achieved by filling it with the bone grafting material and inducing the formation of new bone, by guiding bone producing cells (osteoblasts) to the affected area.

This technique can be used to repair bone defects around teeth or implants. GBR can be performed at the same time or prior to implant placement, depending on the case at hand.

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Socket Preservation

Socket Preservation is a procedure in which graft material or scaffold is placed in the socket of an extracted tooth to preserve the alveolar ridge. After extraction, jaw bones may need to be preserved to keep sockets in its original shape. Without socket preservation, the bone is susceptible to resorption.
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Osteome Summers Technique

Depending on the individual case at hand, bone volume around the maxillary sinus may need increasing to ensure sufficient implant-supporting structure. A technique pioneered by Dr. Robert Summers, Osteome Summers provides a less invasive approach to placing implants near the sinus floor.

There are two applications of this technique: The preparation and creation of the implant site, which previously lacked adequate bone structure for a successful placement, then; a procedure to increase the bone density of the treatment area.

Geistlich BioMaterials

Used for 95% of bone grafting procedures at our practice, Geistlich are market leaders in biomaterials for regenerative dentistry. Primarily, we use Bio-Oss and Bio-Gide in our bone grafting treatments.

Bio-Oss is a bovine derived bone substitute possessing osteo-conducive properties, which increase the likelihood of successful bone regeneration. Bio Gide promotes wound healing and supports unencumbered bone regeneration.

Used in tandem, Bio Oss and Bio Gide provide long-term implant survival rates and positively aesthetic results for Marylebone Implant Centre patients.

Horizontal vs Vertical Bone Graft

Bone defects can be classified as horizontal or vertical. When the bone is missing in height, it’s known as a vertical defect, and in width, a horizontal defect. Combined defects, when there is bone missing in both height and width, do occur and are the most difficult to repair.

In a horizontal defect, the bone grafting procedure may be completed at the same time as the implant placement if there is enough bone to stabilise the implants. Otherwise, the bone graft may need to be performed prior to implant placement.

Typically, a vertical bone defect will require the bone graft to be performed first. At a later stage, once the bone is mature, the implants would be placed. In a combined defect, the approach would be similar in terms of stages.

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Marylebone Implant Centre, Experts in Implant Dentistry

We pride ourselves on the utmost care & transparency with patients before, after and during treatment. Our treatment plans include all fees and information on time scales; there are no hidden costs. Our highly-experienced clinicians are all registered under the GDC.

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