Bone Grafts are Not all the Same

People often get confused regarding the many types of bone grafting. Today it is possible to significantly regrow bone that is lost through time, or, it is common occurrence that a bone graft is initially placed when a tooth is extracted, just to find out that there is still not enough bone to place an implant. Thus, there are many other types of bone graft techniques and bone graft materials and technology to address this issue.

Site Preservation Bone Graft: After an extraction, bone graft material is packed into the extraction socket to preserve as much as the existing bone as possible; This type of graft is not designed to regrow a ridge that has shrunk over time, but only to help to preserve as much bone as possible that is already there.

Sinus Lift Bone Graft: Often if an upper tooth is extracted many years ago, the existing bone will shrink, and the sinuses get larger (pneumatization) resulting in a short bone height. If an implant is placed, it will therefore poke into the sinus, however, it is possible to lift the sinus membrane and graft bone so that bone will enclose the whole implant. This will strengthen the support of the implant.

Guided Bone Regeneration Bone Graft: This technique is probably the “gold standard” for regrowing the thin and shorter bone height ridges. Granulated bone is “shaped” and secured with membranes to increase thickness and height of resorbed ridges of bone, enough so, that implants can usually be placed.

Onlay Block Bone Graft: A block of bone is shaped and secured to a resorbed ridge. This technique is usually not as predictable as GBR, and because of the difficulty of the blood vessels to penetrate a block of bone, may result in greater shrinkage when healing.

Bone graft Materials:

As with bone graft types, there are many bone graft materials, each with their advantages/disadvantages. Often we may combine the materials in different ways to get the desired results.

Autograft: Your own harvested bone.

Allograft: This is a Freezed Dried Human Bone product.

Xenograft: This is a Freeze Dried Animal Bone product. The most common animal bone is sourced from cows, pigs, horses, and even camels

Synthetic: The most common synthetic grafting granules are made from tricalcium phosphate (TCP), however other grafting particles such as Hydroxyapatite are not usually used with implant s because their lack of resorption and being “hard as a rock” to drill through; Concrete.

Growth Factors (healing proteins). These are usually grown synthetically, or extracted from your blood and combined with the bone particulates listed above.

It’s Not Only The Bone, It’s the Soft Tissue Too!

For long-term life and stability, there must be adequate soft tissue (gums) around the implant for bacteria seal. As the “Bone sets the Tone, the Soft Tissue is the Issue”. There are basically two kinds of soft tissue, the thin easily movable type, and the thicker non-movable “keratinized” type. The thicker “keratinized” type of gums is more desirable.

Also for long-term stability, there must be adequate thickness above the implant. As with bone, be can grow tissue as we need it in most cases.

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