Replacing Bone for Dental Implants

Gum disease adversely affects the gum tissue and can lead to tooth loss, but it also affects the bones of the jaw. When gum disease progresses, bacteria infects all the tissues of the periodontium, which is the specialized set of structures that support the teeth. The periodontium is made up of the bone, the gum tissue, the ligaments that hold the teeth in place, and hard tissue that makes up the roots of the teeth. In its earlier stages, gum disease is called gingivitis, as it primarily affects the gingival, or gum, tissues. As it progresses, the bacteria that cause gum disease begins to adversely affect all the tissues of the periodontium, and, in its later stages, gum disease, now called periodontitis, can cause the bone that makes up the jaw to degrade and be reabsorbed by the body. This is why people who have no teeth may have a sunken appearance in their lower face. In order to support dental restorations like dental implants, if there is an inadequate amount of healthy bone present, bone graft surgery may be necessary. The goal of bone grafts is to reinvigorate the bone tissue and help healthy bone develop, as healthy bone is a requirement for dental implant treatment.

Gum disease develops when detrimental bacteria accumulates on the teeth and below the gum line, initially affecting the gums and eventually the bone that supports the teeth. This bacteria accumulation is usually a result of poor oral hygiene. When bacteria remain on the teeth for a prolonged period, in the form of plaque and tartar, they colonize and thrive, leading to inflammation in the gums. In its early stages, gingivitis causes swelling in the gums, and the gums may also bleed when brushed or probed. When gingivitis is detected early, it can be reversed relatively easily. However, once the other tissues of the periodontium begin to be affected and periodontitis develops, the damage is irreversible. When bacteria collect at the gum line, the toxins they secrete enter the gum tissue, below the gum line, and infect the tissues of the oral cavity, gradually destroying the periodontal ligament that attaches the teeth to the bone, and, in its late stages, ravaging the bone tissue that holds the teeth in place. The teeth will eventually loosen and fall out, and the bone will continue to degrade in the absence of healthy tooth roots.

While periodontitis isn’t reversible, it is possible to repair a good part of the damage that can be caused by advanced gum disease. Bone graft surgery is a highly effective surgery that can help regenerate lost bone, creating a stable and healthy setting for a dental implant. In a bone graft procedure, a periodontist will make an incision in the gums, folding them back to clean away any infected gum tissue and removing built-up tartar from the tooth surfaces. The periodontist may also smooth the surface of the tooth below the gumline to prevent bacteria from building up in the future by giving it fewer surfaces to cling to. Once the area is thoroughly cleaned and free of bacteria and dead tissue, the bone graft material is placed in the jaw. When only minor bone grafts are needed, it may be possible to place the bone grafts and the dental implants in the same procedure. In more complicated cases when a significant amount of bone has been lost, healing occurs over the course of several months, during which time new bone gradually replaces the graft material. Once healing is complete, the bone is ready to support a dental implant.

Bone graft material can be natural bone or synthetic bone, and each type of bone graft is named for the material that is used in the procedure. An autograft is a bone graft that uses a patient’s own bone, which is usually derived from the patient’s hip or another part of the jaw. An allograft uses bone that has been acquired from a human donor, while a xenograft uses bone that has been acquired from an animal; the most common type of xenograft is bovine, which uses bone from a cow. An alloplast doesn’t use bone at all, instead relying on a synthetic material that is made up of phosphorus, hydroxylapatite, and phosphorus. Each bone graft material comes with its own advantages and disadvantages, and your dentist can help you make an informed decision about which type of graft you’d prefer. There are also options for tissue regeneration, which can complement bone graft procedures and increase their efficacy. One tissue regeneration procedure, called guided tissue regeneration, uses a tiny piece of surgical mesh placed into the space between the bone and the gum to prevent the gum tissue from filling in a space where new bone needs to grow, allowing space for the bone. Other options for tissue regeneration include growth factor proteins, and new techniques and graft materials are consistently researched, both individually and in combination. Dentists hope that these therapies might eventually be used to help people keep their natural teeth longer, and research continues.

Bone graft procedures are usually successful and can help grow bone that will support dental implants for a long time, but when grafts are needed before an implant procedure, the whole treatment ends up taking a very long time. The better solution to the problem is to prevent the bone from being damaged in the first place, by preventing gum disease from starting or progressing. Luckily, for most people, all it takes to prevent gum disease is proper oral hygiene. Brush the teeth at least twice daily with a soft-bristled toothbrush and fluoride toothpaste, and be sure to brush the gum lines extra carefully, as this is where bacterial plaque likes to gather and wreak havoc. Clean between the teeth with dental floss or another interdental cleaner daily, and make sure to clean out any food debris that might remain after brushing. Most importantly, visit your dentist periodically. Gingivitis, in its early stages, can be asymptomatic, and it may be the case that only a dentist or dental hygienist can detect it at this point, but remember: when detected early, gum disease can be reversed. If you could prevent yourself from ever needing bone graft surgery, wouldn’t you do whatever you could? Conscientious oral hygiene, including regular dental visits, can be your solution, and it could even help you keep your natural teeth in good condition for a lifetime.