INTERACTIVE DENTAL IMPLANT INFORMATION

The great majority of bone grafts required for implant placement are minor procedures which can easily be accomplished in the office under local anesthesia or intravenous sedation. Major bone grafts are utilized to repair extremely large defects of the jaws. These major defects usually result from severe traumatic injuries, tumor surgery, and congenital defects. Large defects are always repaired using the patient’s own bone. Since a large amount of bone is needed to repair these extensive defects, the bone must be harvested from areas where there is an abundance of available bone. This bone can be 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 performed in an operating room and require a hospital stay.

The socket preservation graft is an extremely simple and important bone graft procedure. This procedure must be accomplished at the time of tooth extraction. It helps to preserve bone at an extraction site in preparation for future implant placement. The area of the jaw bone that holds a tooth in place is called a tooth socket. Preservation of bone volume and architecture (shape) is crucial for implant stability and esthetics. After a tooth has been extracted, the supporting bone (socket) begins to rapidly melt away (bone resorption). Post-extraction bone resorption tends to be particularly severe in sockets with thin walls of bone. A socket preservation graft placed immediately after tooth extraction helps to preserve bone volume and architecture by minimizing post-extraction bone resorption. This procedure diminishes the likelihood that a more complicated bone graft will be necessary prior to implant placement. In many cases, this simple graft is all that is required to provide sufficient bone for implant placement. In some cases, due to severe inflammation at the extraction site, a low maxillary sinus, extensive preexisting bone loss and/or diseased tissue at the extraction site, it is not possible to provide enough bone volume for implant placement with this procedure alone. In these circumstances additional bone grafting may be required either at the time of implant placement, or as a staged procedure prior to implant placement.

The tooth is extracted with great care leaving as much socket bone intact as possible. After the tooth has been extracted, the socket is gently but thoroughly cleaned and debrided. A specially prepared particulate cadaver bone graft is inserted into the socket and retained in place with a with a small collagen plug which is sutured over the socket. The collagen plug falls out by itself a week or two later, the sutures dissolve and fall out in two to three weeks. The site is reevaluated for implant placement four months after grafting; if sufficient bone is present the patient is ready to be scheduled for implant surgery.

If you require a tooth extraction and you are thinking of replacing the tooth with a dental implant, a consultation visit is strongly recommended prior to the extraction appointment so that our doctors can determine the best way to proceed and inform you of all treatment options. Please see our information regarding dental implants, tooth extraction and dental implant video on this website for detailed information concerning these topics.

When severe bone loss has resulted in a ridge that is too narrow to support a dental implant, there are several bone grafting options available:

Guided Bone Regeneration Socket Reconstruction Graft

Particulate cadaver bone grafts have many uses in implant dentistry. They are often utilized in cases where there is sufficient bone to provide initial implant stabilization, but there is inadequate bone volume to fully cover the implant. In these cases the graft can be placed simultaneously with implant insertion. A small collagen membrane may be required to contain the graft and prevent soft tissue (gum tissue) from interfering with new bone formation. The membrane is broken down and eliminated by the body so removal at a future date is not necessary. This technique is often referred to as guided tissue regeneration, or guided bone regeneration.

The simple socket preservation bone graft technique, previously discussed, can be accomplished immediately after tooth extraction with excellent results when there is minor to moderate tooth socket bone loss. However, when there is severe socket bone loss due to infection, traumatic injury or the extraction process, simple socket preservation is not possible since the socket is no longer intact. Guided bone regeneration can be utilized immediately after tooth extraction to reconstruct the tooth socket when the socket has been largely or completely destroyed. Immediate socket reconstruction with particulate cadaver bone graft and collagen membrane is a fairly simple procedure which can often regenerate sufficient bone volume and satisfactory ridge architecture to permit implant placement four to six months after grafting. This procedure must be accomplished at the time of tooth extraction. A socket reconstruction graft diminishes the likelihood that more complicated bone grafting will be required prior to implant placement.

A ridge split is performed in cases where the ridge is too narrow to place an implant but wide enough to split. There must be sufficient bone height for initial implant stabilization to accomplish this procedure. The crest of the ridge is split along its length between the outer cortex and inner cortex. The ridge is carefully expanded as the implant is inserted. This creates a void in the center of the split ridge which is filled with a specially prepared freeze-dried cadaver bone graft. The implant is buried beneath the gum tissue and allowed to heal for six months. When this procedure is accomplished in the mandible, the procedure must be staged due to the dense non-elastic nature of the mandibular bone. The bone cuts (osteotomies) are accomplished three weeks prior to implant placement. This three week healing period assures excellent blood supply to the expanded bone by allowing the gum tissue to reattach to the bone in the area of the osteotomies before expansion takes place.

An onlay cortical bone graft is performed in cases of moderate to severe bone loss. A small block of bone is harvested from the chin or the mandibular ramus (just posterior to the lower wisdom tooth area). These donor sites are surgically approached from within the mouth. The block of bone is screwed into the recipient site (future implant site) with specially designed tiny surgical bone screws. The area is allowed to heal for 4 to 6 months, at which time the screws are removed and the implant is placed.

Occasionally a deficiency in healthy attached gingiva (gum) necessitates a gingival graft prior to implant placement. If a gingival graft is required after a cortical bone graft has been accomplished, it is performed at the time of screw removal. The implant can be placed approximately three months after gingival grafting.

The maxillary sinuses are located above the roots of the upper posterior teeth and below the eye socket. The maxillary sinuses are positioned behind the cheeks on either side of the nose. Sinuses are like empty rooms that are filled with air. The floor of the maxillary sinus is located just above the roots of the upper molars and second premolar. Frequently, the roots of these teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin layer of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. A thin sinus floor will not provide enough bone to support a dental implant.

The solution to this problem is called a maxillary sinus graft or maxillary sinus lift graft. Kandor dental’s dentist creates a small window in the thin bone on the lateral sinus wall where the maxillary posterior teeth had previously been extracted. The delicate sinus membrane is carefully exposed then lifted upward and a bone graft is inserted beneath the membrane into the floor of the sinus. The bone graft is usually a combination of specially prepared freeze dried cadaver bone or bovine bone and bone harvested from the patient’s upper or lower jaw. After six months of healing, when the bone becomes solid enough to support an implant, the implants are placed.

The sinus graft makes it possible for many patients to have dental implants when years ago their only option was to wear dentures, partial dentures or bridges.

In many cases the bone beneath the sinus floor is slightly deficient but there is sufficient bone height to provide initial implant stabilization. In these situations sinus grafting and implant placement are performed simultaneously. This remarkably simple bone graft procedure is called a simultaneous internal sinus lift. It is internal because the sinus floor graft site is approached from within the implant preparation site. This is an elegant surgical technique which adds only a few minutes to the implant procedure and reduces the total healing period by approximately six months.

Bone loss can occur in the upper and lower jaws for several reasons. Localized bone loss often occurs around diseased teeth due to periodontal (gum) disease, fractured teeth, traumatic injuries and dental infections. In addition, over a period of time the jawbone associated with missing teeth atrophies (bone resorption/shrinks). This often leaves a condition in which there is poor quality and quantity of bone, unsuitable for placement of dental implants. In the past, patients with significant bone loss were not candidates for placement of dental implants.

With current bone graft techniques, we have the ability to grow bone where needed. Augmentation bone grafts can be accomplished virtually anywhere on the upper and lower jaws. This enables us to offer dental implants as a replacement for missing teeth to almost all patients, even if substantial bone loss has occurred.

Commonly used bone graft materials include autogenous bone (your own bone), cadaver bone (bank bone), bovine bone and synthetic bone. The selection of graft material and surgical technique are based on the location and severity of the bone loss. In most cases, specially prepared cadaver bone and/or autogenous bone are utilized. Autogenous bone is usually taken from other areas of the upper or lower jaw.

Dental implants are designed to provide a foundation for replacement teeth that look, feel and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved. The dental implants are tiny titanium posts, which are placed into the jawbone where teeth are missing. The bone bonds with the titanium, creating a strong foundation for artificial teeth. In addition, dental implants can help preserve facial structure, preventing the bone deterioration, which occurs when teeth are missing.

Dental implants are changing the way people live! With them, people are rediscovering the comfort and confidence to eat, speak, laugh and enjoy life.

EVALUATION FOR DENTAL IMPLANTS

If, like many others, you feel implant dentistry is the choice for you, we ask that you undergo a dental/radiographic examination and health history. During this consultation visit, your specific needs and considerations will be addressed by Kandor Dental’s doctors. Your questions and concerns are important to us and our team will work with you very closely to help make your procedure a success.

DENTAL IMPLANT PROCEDURE

Dental implants are metal anchors, which act as tooth root substitutes. They are surgically placed into the jawbone. Small posts are then attached to the implant, which protrude through the gums. These posts provide stable anchors for artificial replacement teeth.

For most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone. For the first three to six months following surgery, the implants are beneath the surface of the gums, gradually bonding with the jawbone. You should be able to wear temporary dentures and eat a soft diet during this time. At the same time,in Kandor Dental we design the final bridgework or denture, which will ultimately improve both function and aesthetics.

After the implant has bonded to the jawbone, the second phase begins. The implants will be uncovered and a small healing collar will be attached. In Kandor Dental, we can then start making your new teeth. An impression must be taken. Then posts or attachments can be connected to the dental implants. The replacement teeth are then made over the posts or attachments. The entire procedure usually takes six to eight months. Most patients do not experience any disruption in their daily life.

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a metal healing abutment protruding through the gingival (gum) tissue.

BLEEDING

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding (your mouth fills rapidly with blood) can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues profusely, please call for further instructions.

SWELLING

Swelling is a normal occurrence after surgery. To minimize swelling apply an ice bag, or a plastic bag or towel filled with ice, on the cheek in the area of surgery. Apply the ice continuously, as much as possible, for the first 36 hours.

DIET

Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.

PAIN

You should begin taking pain medication before you feel the local anesthetic wearing off. For moderate pain, Take 1 Tylenol and 2 Ibuprofen (Advil or Motrin) at the same time. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 3-4 hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic to them, or have been instructed by your doctor not to take it.

ANTIBIOTICS

You already took them. Dr. Ouellette gives a large dose up front prior to surgery and this will cover you for the next few days. Dr. Ouellette will prescribe additional antibiotics if grafting procedures were also performed.

ORAL HYGIENE

Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex Oral Rinse before bed. The day after surgery, the Peridex should be used twice daily; after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt water rinses (one teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day as well, especially after meals. Brush your teeth and the healing abutments. Be gentle initially while brushing the surgical areas. Remember a clean wound always heals faster.

ACTIVITY

Keep physical activities to a minimum immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking in normal nourishment. This may weaken you and further limit your ability to exercise.

WEARING YOUR PROSTHESIS

Partial dentures, flippers, or full dentures, should not be used immediately after surgery for at least 10 days, as discussed in the pre-operative consultation.