Bone grafting to add bone volume
At Skin & Smiles over 30% of our implant cases require some type of bone grafting. We have a success rate of over 98% in this procedure and so if you require this type of grafting you will be in good hands. A common abbreviation for this process is GBR.
When you are assessed for an implant placement we look at bone volume, quality and density. This is done with X-ray imaging (either intra-oral or CT scans) as well as with clinical examination of the site.
We have over 10 years of experience in this sort of treatments and so we can usually tell you whether or not you may need grafting at your first visit and then this will be added to your treatment plan. In most cases we will graft at the time of implant surgery but in some cases when there is not enough bone to place at implant the grafting procedure may need to be done separately. If this is the case you will be advised.
There are numerous materials that are currently available for increasing bone. We will inform you about the alternative treatment methods and the materials that are available. On the whole we tend to use a synthetic graft material but we may also use a bone substitute of bovine (cow) origin or even of human (cadaveric) origin. There is, of course, the option of using your own bone in the graft procedure. This tends to require more than one surgical site and has its own pros and cons. We will discuss this with you.
If you do not have enough of your own bone available for us to be able to stabilise a tooth or to securely anchor a dental implant, GBR will be used to increase your own bone, thus providing us with an adequate amount for the procedure you require. Graft materials act a solid scaffold which serve as a guide-rail to allow new bone to grow.
This scaffolding material enables and facilitates bone formation in the area where the operation is performed. It is inserted into the operation area in the form of grains or small blocks. Your own bone slowly grows into the graft material, which at a later time is gradually broken down by the body.
Synthetic Bone Grafting
At Skin & Smiles 90% of our grafting is done with a fully synthetic, two-phase calcium phosphate ceramic consisting of 60% hydroxyapatite (the material that tooth enamel is made from) and 40% ß-tricalcium phosphate. Bone regeneration is supported by this mineral composition, similar structure to bone and the resulting resorption characteristics.
The particulate is placed into the void either beside/against an implant or into a void to preserve the natural shape of bone. It is then wrapped with a collagen membrane (see below). Healing will take between 3-4 months in most people but longer in those that may have medical conditions such as diabetes and osteoporosis.
Bone grafting of any sort is negatively affected by smoking as this reduces the blood flow to the oral tissues. We will advise you to stop smoking for at least 4 days before and 4 days after surgery if you will be having any sort of grafting. If you continue to smoke after this period and the graft is not successful then subsequent procedures may not be possible or be adversely affected.
We recommend the use of high dose Calcium supplements to aid the body during healing when you have had a graft. These are readily available from High Street stores such as Holland & Barrett. Calcium metabolism requires the presence of Vitamin D and so we recommend a combined supplement.
Your own (Autogenous) Bone
We can use the body’s own bone, which is taken from a different location, for example the local area to the primary surgical site, the chin or back of the lower jaw. However this procedure requires additional anaesthesia. Once the bone is harvested from its original site it is then inserted into the operation area. In this procedure, the following must be considered:
- There is now a second area of operation, which may be associated with additional pain or loss of sensitivity.
- It is possible that the amount of the newly gathered bone will not be adequate for the intended purposes.
Bovine-origin Bone Grafting
This is a bone replacement material that is used to increase the body’s own bone. It is composed of the hard, mineral portion of natural bone and has a structure very similar to that of human bone. It is therefore well accepted by human bone tissue and serves as a guide-rail for the new bone growth.
The starting material is carefully inspected bovine bone that has undergone treatment with patented processes for purification and sterilisation. Included amongst these processes is the treatment at high temperature for more than 15 hours, after which it is highly purified and finally sterilised.
In certain procedures, collagen blocks are used for regenerating bone. This product is the same as the particulate described above, but has highly purified natural collagen fibres added to it. The collagen is of porcine origin (obtained from pigs).
A membrane made of collagen is generally used to cover the bone replacement material. It has been proven that better healing rates are achieved when the bone particles are covered with a membrane because the tissues of the gum grow more rapidly than the new bone and the membrane protects the particles from this faster growing connective tissue. This ensures that the underlying bone can heal in an undisturbed fashion.
The membranes are composed of highly purified natural collagen obtained from pigs. The collagen membrane becomes completely broken down by the body, hence a further operation to remove it is unnecessary.
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Last Updated: 7th April 2019 at 2:07 pm