Replacing Bone for Dental Implants
Dental implants are an ideal way to replace missing teeth but like most medical procedures, there are certain prerequisites needed in order to be a candidate for the treatment. One such requirement for dental implant surgery is that the patient have sufficient jawbone density. Should the patient have advanced gum disease (periodontitis), some of the bone holding the teeth in place could have been lost and a dentist or periodontist may recommend a bone graft.
Periodontal Disease and Bone Loss
Despite it being common knowledge that untreated periodontal (gum) disease can lead to the loss of teeth and gum tissue, many people fail to realize that bone loss in the jaw is also possible. Typically due to inadequate oral hygiene, gum disease begins when bacteria and plaque accumulate causing gum tenderness and inflammation. During the initial stage, called gingivitis, the gums may swell and easily bleed.
Left untreated, gingivitis progresses into a more severe form of periodontal disease called periodontitis. It occurs when the toxins and bacteria produced by plaque penetrate under the gumline, infecting the tissues beneath the teeth. At this point, the tissues and bone holding the teeth in place are broken down by the infection and if not treated, damage will continue to the point where the teeth will loosen and eventually fall out due to the lack of support.
Common symptoms of periodontal disease include:
- Chronic bad breath
- Bleeding or swollen gums
- Loose teeth
- Teeth sensitivity – hot and cold
- Pain when chewing or eating
Adult tooth loss is most commonly caused by periodontal disease but treatments, including bone grafts, are available to help resolve periodontal disease damage.
Bone Grafts and Periodontal Disease
To replace bone that supports the teeth, a periodontist may perform a bone graft. During a grafting procedure, the gum tissue is first folded back, and the periodontist cleans out any bacteria, infected gum tissue, and smooths any rough surfaces. Bone material is then placed which helps the body build new bone. A bone graft helps repair gum disease damage and can enhance the patient’s odds of keeping their teeth.
The type of bone graft varies based on the materials used:
- Autograph: uses the patient’s own bone – typically from the back of the jaw or hip bone
- Allograft: uses human donor bone
- Xenograft: uses bone sourced from an animal – often a cow
- Alloplast: uses bone grafted from synthetic materials containing phosphorous, hydroxylapatite, and calcium.
Traditionally, bone grafting procedures involved harvesting bone tissue from one area of the patient’s body or jaw and transplanting it into their jawbone. Today, replacement bone is often obtained from a cadaver or animal source for transplantation. While equally successful, these options are less invasive, prevent a second surgical area, and reduce patient morbidity. There are pros and cons with the various grafting materials and procedures so patients should discuss with their dentist which is ideal for their situation.
- Dental bone grafts can be further broken down into three main procedure types with each having different uses for resolving jaw conditions.
- Block bone graft – takes bone from the back of the jaw, near the wisdom teeth; useful when the front of the jaw suffers significant bone loss.
- Sinus lift – done to restore upper jaw stability and sinus position in cases where bone loss occurs near the upper molars.
- Socket graft – bone graft done in conjunction with tooth extraction to avoid bone loss that otherwise might occur after removing the tooth.
Are Bone Grafts Painful?
The amount of pain or discomfort associated with a bone graft varies based on the material selected for the procedure. Grafts that do not involve removing bone from the patient’s body, are fairly minor procedures. The procedure is performed under sedation so the patient will not experience any pain during surgery. Once the anesthesia wears off, pain is generally mild for a few days and manageable with over-the-counter pain relievers.
Should bone be harvested directly from the body of the patient, recovery can be more painful and take longer since surgery is performed in multiple locations, such as the hip and jaw. In these cases, prescription pain medication may be needed and depending on the extent of work done, discomfort could last for several weeks while recovering.
Bone Graft Cost
Bone graft procedures can vary in cost considerably but the two factors that most influence cost are the material used and the procedure’s complexity.
When animal, cadaver, or synthetic materials are used for a bone graft, the procedure typically can cost between $400 to $1,200. Should the procedure use material harvested from the patient’s body, it could cost $2,000 or more. In most cases, the patient will bear the full cost of the procedure because many insurance carriers, including Medicare, do not provide coverage for dental bone grafts unless it is determined to be medically necessary. Should grafting be merely cosmetic, any insurance assistance is unlikely.
Recovering from a Dental Bone Graft
Following a dental bone graft, the dentist will likely pack the area around the incision with gauze. Instructions will be given how the dressing should be changed over the next 24 hours and antibiotics will be prescribed to avoid infection. Prescription pain relieving medication could also be given.
Additional post-operative tips include:
- Applying an ice pack for the first day or two to reduce swelling and pain
- Stick to a diet of soft foods a few days following surgery
- Sleep with the head elevated slightly for a few nights to prevent blood from pooling at the incision site
- Avoid hot liquids like soup or coffee
- Refrain from crunchy or hard foods like nuts or chips
- Avoid strenuous physical activity, like contact sports, that could jeopardize the incision
Swelling and pain are the primary side effects but minor bleeding and difficulty speaking or chewing are also possible during the initial days following surgery. Within about a week, discomfort should dissipate and the jaw will feel like it is improving. However, it will likely still take a few months until the jaw is sufficiently strong to support implants.