When we consider dental implants, it is often necessary to discuss bone grafting. A bone graft is often required to restore bone to the areas where teeth have been removed.

Alveolar bone is made up of small alveoli, which gives it its porous aspect. When a tooth is lost, this bone has a tendency to disappear due to lack of stimuli. When losing a tooth, the portion of the bone that is most likely to disappear is the one located on the buccal side being that of the cheek side. When we lose many teeth on an arch, the whole ridge eventually becomes resorbed, especially if a partial or a complete denture is worn which accelerates resorption due to the pressure on the arch.

There exists many bone grafting techniques which can be summarized as follows:

Cortico-cancellous bone graft: necessary when an important loss of bone structure and the receiving site has good vascular potential. The bone is often taken from the mandible (lower jaw) but can also be retrieved from the hip by your maxillofacial surgeon if a more important amount of bone is necessary prior to the insertion of implants.

Bovine particulate bone graft: graft often used when placing an implant to fill a small bone deficit, often associated with the loss of a single tooth. This type of graft has been widely used over the past 15 years and is a world standard for long term aesthetic restoration. Complications associated with this procedure are rare as long as the standard recommendations of this technique are meticulously observed.

Sinus graft: necessary when the maxillary sinus has expanded following the absence of dental roots. A grafting technique of bone particles placed in a window created in the posterior maxillary region can easily be performed by your maxillofacial surgeon. Experience in jaw surgery (orthognathic surgery) identifies the maxillofacial surgeon as the skilled and knowledgeable person to perform such a procedure. The success rate of this procedure is high if all the steps and conditions surrounding the surgery are observed.

Inter-positional graft: This technique is often called the ‘sandwich graft’ where we section an alveolar bone segment by increasing the height of the bone ridge. The elevation equals the desired increased height and the space created is often filled by bone particles. The advantage of this technique is a result of stability while increasing the ridge since the terminal part that constitutes the increase remains vascularized.

Graft using sponges soaked in BMP (Bone morphogenic proteins) and covered with titanium mesh: a more recent and promising technique. This technique uses proteins that promote bone formation. Absorbable sponges are used to withhold these proteins. The ridge shape is given by the titanium mesh, which is molded in the clinic and temporarily placed.

The type of graft depends on many factors as well as your own dental condition. Your maxillofacial surgeon will be able to advise you on the best option offered for your case.

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