Bone augmentation procedures
Bone augmentation / Bone augmentation procedures
Whether bone augmentation is necessary depends on the quality of the bone and whether bone loss has already occurred due to prolonged toothlessness. Sufficient bone quantity (height, width, density) and bone quality form the basis for safe implant placement.
If there is insufficient bone mass, there are various techniques in dentistry to replace missing bone substance. These procedures all differ in terms of complexity and cost. If only a small amount is needed, bone chips produced during the procedure can be used for this purpose (bone grafting).
The patient’s own bone material or artificial bone replacement material can be used for bone augmentation. The procedure used for bone augmentation depends largely on the existing bone and its location (upper or lower jaw, front or side teeth). The following methods are possible, depending on the initial situation:
Sinuslift
The sinus lift method is used when the jawbone in the upper jaw is too thin in the area of the posterior teeth. Prolonged toothlessness causes the bone to recede due to the lack of chewing force. This allows the underlying maxillary sinus to expand further. If an implant were to be placed at this point, there would not be sufficient stability, as the implant could potentially protrude into the maxillary sinus. The sinus floor is the bone plate between the maxillary sinus and the oral cavity – and this is now raised (lifted) by inserting bone material. This creates additional millimeters of bone. A distinction is made between external and internal sinus lifts.
In an external sinus lift, access to the bone is gained at the side of the upper jaw and the sinus floor is carefully lifted. The space created is filled with bone mass (partly the patient’s own bone, partly bone replacement material). After a sufficient healing period, the implant can be safely inserted. Under certain conditions, the implant can also be inserted during bone augmentation. In this case, a firm fit must be ensured.
In an internal sinus lift, the floor of the maxillary sinus is raised from the implant hole. The implantologist lifts the maxillary sinus floor. Special instruments are used to detach the mucous membrane of the maxillary sinus and then push it upward. This creates a cavity between the mucous membrane and the rest of the jaw ridge. This cavity can be filled with the patient’s own bone or with bone replacement material.
Bone spreading
In the bone spreading method, the jawbone is too narrow and is split vertically using a special chisel to obtain sufficient width for the insertion of an implant. The implant is inserted into the resulting gap and the remaining spaces are filled with bone mass.
Bone splitting
The bone splitting method is used when the affected jawbone is too narrow even for spreading. Here, too, the bone is split and usually has to be stretched in addition in order to be able to insert an implant. As with bone spreading, the remaining space is filled with bone material after the implant has been inserted.
Distraction osteogenesis
This method is used to achieve an increase in the jawbone. This means that the jawbone is split horizontally into a lower and an upper part. A special screw is fixed to the bone in the split and then screwed in further at short intervals. The tissue surrounding the so-called fracture gap now regenerates and new bone formation occurs. However, the screw attached to the ends of the bone must be worn by the patient for several weeks in order to achieve the desired result.
Socket preservation
Socket preservation refers to measures taken to prevent the gums from sinking into a gap left by a missing tooth. For example, the gap can be filled with bone replacement material and, once the bone has healed or fused, an implant can be inserted. The aim is to prevent possible bone loss. This can also be achieved by inserting an implant immediately after the tooth has been extracted.
There are other methods for creating more bone mass or shaping it in such a way that an implant can be inserted safely:
- Bone block transplantation
- Onlay osteoplasty using autogenous bone (alveolar ridge augmentation)
- Cavity technique
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