Bone grafting of the jaw is a surgical procedure necessary in cases of jawbone deficiency for the purpose of dental implant placement. Bone grafting can be performed in both the lower and upper jaws.
CAUSES OF JAW BONE RESORPTION
Defects of the alveolar ridge of the jawbones most commonly occur as a result of bone resorption due to inflammation around the tooth roots. They can also result from bone loss during tooth extraction or trauma.
From the perspective of static planning and optimal layout for later prosthetic rehabilitation, these defects are often located in ideal sites for implant placement.
JAW BONE GRAFTING – INDICATIONS FOR THE PROCEDURE
In cases where it is not possible to achieve primary stability of the implant in the alveolar bone above or below the defect margin, it is indicated to fill the defect with a bone autograft or substitutes for natural bone.
The bone graft integrates into the bone, functioning as a sort of graft and an additional source of minerals that promotes osteogenesis – the new formation of bone or its revitalization. In cases of its application, implantation is postponed for at least six months.
For jawbone grafting, the following is used:
Autografts are always best accepted by the body because they involve the patient’s own tissue. Since the autogenous bone graft is completely biocompatible, the risk of rejection is minimized.
This surgical intervention is performed under local anesthesia or analgesosedation, making it painless for the patient.
HOW IS JAW BONE GRAFTING PERFORMED?
Since bone grafting increases the volume of bone in all dimensions, a mucoperiosteal flap must be mobilized by incising the periosteum. The aim of this procedure is to suture the flap to the palatine side of the incision without tension.
When reconstructing a defect to restore the height of the alveolar bone, a bone autograft in the form of a block should be applied, and the remaining empty spaces filled with granules of artificial bone or spongiosa.
Such a graft should be covered with a commercial resorbable membrane or periosteum as an autograft.
Using a membrane prevents soft tissue ingrowth through the existing spaces between the granules. This way, the surface of the bone becomes smooth, making it easier to separate the periosteum in a later procedure during implant placement.
When the bone defect is filled with granules and not covered with a membrane, the granules tend to migrate through the periosteum, even into the mucosa. This significantly complicates the separation of the periosteum during implantation.