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Oral surgeon bowie, md

PRESERVING YOUR JAW BONE AFTER EXTRACTION

  • Removal of teeth is sometimes necessary because of pain, infection, bone loss or fracture of the tooth. The bone that holds the tooth in place (the socket) is often damaged by disease and/or infection resulting in deformity of the jaw after the tooth is extracted. In addition, when teeth are extracted, the surrounding bone and gums can shrink and recede very quickly after the extraction resulting in unsightly defects and collapse of the lips, and cheeks.
  • These jaw defects can create major problems in performing restorative dentistry whether your treatment involves dental implants, bridges or dentures. Jaw deformities from tooth removal can be prevented and repaired by a procedure called socket preservation. Socket preservation can greatly improve your smile’s appearance and increase your chances for successful dental implants for years to come.
  • Several techniques can be used to preserve the bone and minimize bone loss after an extraction . In one common method, the tooth is removed and the socket is filled with bone or bone substitute. It is then covered with gum tissue, artificial membrane, or tissue stimulating proteins to encourage your body’s natural ability to repair the socket. With this method, the socket heals eliminating shrinkage and collapse of surrounding gum and facial tissues. The newly formed bone in the socket also provides a foundation for an implant to replace the tooth. If your dentist has recommended tooth removal, be sure to ask if socket preservation is necessary. This is particularly important if you are planning on replacing the front teeth.

Oral Surgeon Bowie, MD

WHAT IS A SINUS LIFT?

● The maxillary sinuses are behind your cheeks and on top of the upper teeth. These sinuses are empty, air-filled spaces. 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 key to a successful and long-lasting dental implant is the quality and quantity of jawbone to which the implant will be attached. If bone loss has occurred due to injury or periodontal disease, a sinus augmentation can raise the sinus floor and allow for new bone formation. A sinus lift is one of the most common bone grafting procedures for patients with bone loss in the upper jaw. The procedure seeks to grow bone in the floor of he maxillary sinus above the bony ridge of the gum line that anchors the teeth in the upper jaw. By strengthening and growing bone in this location, dental implants can be placed and secured in the new bone growth.

AM I A CANDIDATE FOR A SINUS LIFT PROCEDURE?

  • A sinus lift may be necessary if you:
  • are missing more than one tooth in the back of your jaw.
  • are missing a significant amount of bone in the back of your jaw.
  • are missing teeth due to a birth defect or condition.
  • are missing most of the maxillary teeth, but require support for dental implants.

HOW IS THIS SURGERY ACCOMPLISHED?

In the most common sinus augmentation procedure, a small incision is made on the premolar or molar region to expose the jawbone. A small opening is cut into the bone, and the membrane lining the sinus is pushed upward. The underlying space is filled with bone grafting material, either from your own body or from a cadaver. Sometimes, synthetic materials that can imitate bone formation are used. After the bone is implanted, the incision is stitched up and the healing process begins. 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.

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, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.

The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option besides wearing loose dentures.

A sinus augmentation is generally performed at Dr. Egolum’s office, under local anesthesia. However, some patients also may request oral or intravenous sedative medication as well.

Oral Surgeon Bowie, MD

Ridge and sinus augmentations are surgical dental procedures used to fill in areas of the gum line and underlying bone that have deteriorated as a result of tooth loss or extraction. Specifically, a ridge augmentation refers to the reconstruction of degenerated or underdeveloped gums, and a sinus augmentation refers to an enhancement of the amount and consistency of the maxillary jaw bone by lifting the sinus floor and grafting bone into the jaw line. These state of the art procedures are capable of restoring a natural appearance to, as well as making it possible for some patients to qualify for dental implants.

Did you know…

that tooth loss is not the only reason for getting a ridge or sinus augmentation? Many patients have deteriorated gum lines or inadequate jaw bone support caused by oral diseases, such as periodontal disease, or a physical trauma to the face. Others experience bone atrophy caused by prolonged denture wear. By grafting in bone and building up the gum line, a dentist can make it possible for a patient’s jaw and gums to support permanent dental implants.

Frequently Asked Questions

Am I a candidate for sinus or ridge augmentation?

You may be a candidate for a sinus or ridge augmentation if you have been denied dental implants in the past due to inadequate supporting tissues. You may also qualify if your receded gum line is a source of insecurity or embarrassment. To find out more about sinus and ridge augmentations and whether you qualify, contact your dentist for a consultation today.

What should I expect during a sinus or ridge augmentation?

Ridge augmentations begin with the administration of a local anesthetic used to numb treatment areas and prevent pain. Graft material will then be placed into the tooth socket where the missing tooth once was. Your dentist will then pull surrounding gum tissue over the graft material and suture it shut. Sinus lift augmentations are similar, except your dentist will instead make an incision to expose the sinus floor and use hard graft materials to build up the sinus floor. The site will be sutured shut and allowed time to heal before additional treatments, such as a dental implant, are completed.

Will I need to follow any special instructions following my procedure?

It is normal to experience some swelling and discomfort following your procedure though these symptoms should subside within a few days.

Oral surgeon bowie, md

WHAT IS BONE GRAFTING?

  • Over a period of time, the jawbone associated with missing teeth atrophies and 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 esthetic appearance.

TYPES OF BONE GRAFTS

  • Autogenous Bone Grafts:
  • 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. Depending on your condition, a second procedure may not be in your best interest.
  • Allogenic Bone:
  • 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 it’s 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:
  • 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.

BONE GRAFT SUBSTITUTES

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):
  • This product is processed allograft bone, containing collagen, proteins, and growth factors that are extracted from the allograft bone. It is available in the form of powder, putty, chips, or as a gel that can be injected through a syringe.

Graft Composites:

  • Graft composites consist of other bone graft materials and growth factors to achieve the benefits of a variety of substances. Some combinations may include: collagen/ceramic composite, which closely resembles the composition of natural bone, DBM combined with bone marrow cells, which aid in the growth of new bone, or a collagen/ceramic/autograft composite.

Bone Morphogenetic Proteins:

  • Bone morphogenetic proteins (BMPs) are proteins naturally produced in the body that promote and regulate 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. Dr. Egolum will determine which type of bone graft material is right for you.

Oral Surgeon Bowie, md

The following are the most common causes for jawbone deterioration and loss that may require a bone grafting procedure:

TOOTH EXTRACTIONS:

  • When an adult tooth is removed and not replaced, jawbone deterioration may occur. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and goes away.
  • The rate the bone deteriorates, as well as the amount of bone loss that occurs, varies greatly among individuals. However, most loss occurs within the first eighteen months following the extraction, and continues throughout life.

PERIODONTAL DISEASE:

  • Periodontal diseases are ongoing infections of the gums that gradually destroy the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. While there are many diseases which affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues and are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it always precedes periodontitis.
  • Dental plaque is the primary cause of gingivitis in genetically-susceptible individuals. Plaque is a sticky colorless film, composed primarily of food particles and various types of bacteria, which adhere to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produce toxins or poisons that irritate the gums. Gums may become inflamed, red, swollen, and bleed easily. If this irritation is prolonged, the gums separate from the teeth causing pockets (spaces) to form. If daily brushing and flossing is neglected, plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
  • Periodontitis is affected by bacteria that adhere to the tooth’s surface, along with an overly aggressive immune response to these bacteria. If gingivitis progresses into periodontitis, the supporting gum tissue and bone that holds teeth in place deteriorates. The progressive loss of this bone, the alveolar bone, can lead to loosening and subsequent
    loss of teeth.

DENTURES/BRIDGEWORK:

  • Unanchored dentures are placed on top of the gum line, and therefore do not provide any direct stimulation to the underlying alveolar bone. Over time, the lack of stimulation causes the bone to resorb and deteriorate. Because this type of denture relies on the bone to hold them in place, people often experience loosening of their dentures and problems eating and speaking. Eventually, bone loss may become so severe that dentures cannot be held in place even with strong adhesives, and a new set may be required. Proper denture care, repair, and refitting are essential to maintaining oral health.
  • Some dentures are supported by anchors, which do help adequately stimulate, and therefore preserve bone.
  • With bridgework, the teeth on either side of the appliance provide sufficient stimulation to the bone, but the portion of the bridge that spans the gap where the teeth are missing receives no direct stimulation. Bone loss can occur in this area.
  • By completing a bone graft procedure, Dr. Egolum is now able to restore bone function and growth, thereby halting the effects of poor denture care.

TRAUMA:

  • When a tooth is knocked out or broken to the extent that no biting surface is left below
    the gum line, bone stimulation stops, which results in jaw bone loss. Some common
    forms of tooth and jaw trauma include: teeth knocked out from injury or accident, jaw
    fractures, or teeth with a history of trauma that may die and lead to bone loss years after
    the initial trauma.
  • A bone grafting procedure would be necessary to reverse the effects of bone
    deterioration, restoring function and promoting new bone growth in traumatized areas.

MISALIGNMENT:

  • Misalignment issues can create a situation in the mouth where some teeth no longer have an opposing tooth structure. The unopposed tooth can over-erupt, causing deterioration of the underlying bone.
  • Issues such as TMJ problems, normal wear-and-tear, and lack of treatment can also create abnormal physical forces that interfere with the teeth’s ability to grind and chew properly. Over time, bone deterioration can occur where bone is losing stimulation.

OSTEOMYELITIS:

Osteomyelitis is a type of bacterial infection in the bone and bone marrow of the jaw. The infection leads to inflammation, which can cause a reduction of blood supply to the bone. Treatment for osteomyelitis generally requires antibiotics and removal of the affected bone. A bone graft procedure may then be required to restore bone function and growth lost during removal.

TUMORS:

Benign facial tumors, though generally non-threatening, may grow large and require removal of a portion of the jaw. Malignant mouth tumors almost always spread into the jaw, requiring removal of a section of the jaw. In both cases, reconstructive bone grafting is usually required to help restore function to the jaw. Grafting in patients with malignant tumors may be more challenging because treatment of the cancerous tumor generally requires removal of surrounding soft tissue as well.

DEVELOPMENTAL DEFORMITIES:

Some conditions or syndromes known as birth defects are characterized by missing portions of the teeth, facial bones, jaw or skull. Dr. Egolum may be able to perform a bone graft procedure to restore bone function and growth where it may be absent.

SINUS DEFICIENCIES:

  • When molars are removed from the upper jaw, air pressure from the air cavity in the maxilla (maxillary sinus), causes resorption of the bone that formerly helped keep the teeth in place. As a result, the sinuses become enlarged, a condition called hyper-pneumatized sinus.
  • This condition usually develops over several years, and may result in insufficient bone for the placement of dental implants. Dr. Egolum can perform a procedure called a “sinus lift” that can treat enlarged sinuses.

Oral surgeon Bowie, md

  • When one or more teeth are missing, it can lead to jawbone loss at the site. This loss of jawbone can develop into additional problems, both with your appearance and your overall health. You may experience pain, problems with your remaining teeth, and altered facial appearance, and eventually even the inability to speak and eat normally.
  • In that same way that muscles are maintained through exercise, bone tissue is maintained by use. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and goes away.

POTENTIAL CONSEQUENCES OF TOOTH AND JAWBONE LOSS

  • Problems with remaining teeth including misalignment, drifting, loosening and loss
  • Collapsed facial profile
  • Limited lip support
  • Skin wrinkling around the mouth
  • Distortion of other facial features
  • Jaw (temporomandibular joint TMJ) pain, facial pain, and headaches
  • Difficulty speaking and communicating
  • Inadequate nutrition as a result of the inability to chew properly and painlessly
  • Sinus drooping or expansion

Oral Surgeon Bowie, MD

Bone grafting – also known as ridge and sinus augmentation – is a procedure used to build up the bone beneath the surface of the gums. The bones in the upper and lower arch of the mouth are responsible for supporting the teeth. When one or more teeth fall out, bone resorption occurs naturally. When patients decide to replace missing teeth with dental implants, insufficient bone mass can prevent them from qualifying for the procedure. Bone grafting addresses inadequate bone mass by filling in eroded areas with bone harvested from the patient’s own body, or that of a cadaver or animal. The new bone helps promote new bone growth that will eventually support a dental implant.

Did you know…

that the majority of American adults over age 35 are missing, at least, one natural tooth? What’s more is that 1 in 4 seniors age 74 and older are missing all of their permanent teeth. Although dentures and bridges are a prosthetic option, they do not provide the same benefits available with dental implants. Implant dentistry prevents others from recognizing teeth as ‘false,’ and it also prevents the jawbone from disintegrating and any remaining natural teeth from shifting.

Frequently Asked Questions

Am I a candidate for dental implants?

You may be a candidate for dental implants if you are missing one or more teeth. You’ll need a complete surgical consultation with x-rays to determine whether you are in good health and have adequate bone structure to support dental implants. In some cases where the bone is not dense enough to support an implant, surgical bone grafting may make it possible to support one in the future. It is also important to ensure you do not have any existing health conditions, such as gum disease, that could cause complications with your implants.

What should I expect during a dental implant procedure?

If your oral surgeon determines that dental implants are right for you, expect the procedure to require multiple visits over the course of several months. The first treatment visit is the one when implants will be surgically placed within your jawbone. You’ll be sedated and under anesthesia during the process to ensure your comfort. Once the implants are in place, an impression will be taken and used to form crowns or dentures that will be secured to implant abutments above the gum line. The implants will need to heal for a period of 6 to 9 months before you can return to have your final crowns or dentures placed.

What should I expect during the recovery period?

Dental implant placement is a surgical procedure that requires a period of recovery. During this time, it is common to experience some swelling and soreness, as well as bleeding and minor bruising near the surgical site. Your oral surgeon will recommend eating only soft foods during the first several days following implant surgery. It is also important to follow all instructions for post-surgical care, including cleaning the surgical site and using any medications as prescribed. Be sure to contact your surgeon if you experience any fever or discomfort that worsens after a few days.