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Channel: Bone grafting – Dr. Nima Massoomi DMD MEd MD
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Is that the Easter bunny?

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Easter bunny in a field

 

No, its not.  Those are diverging roots on a fully developed third molar in an adult patient that came to our office in pain for the extraction of his third molars in his 30’S.  Three roots with that level of divergence is a bit unusual and unexpected, especially since it was not clearly visible even in the CBCT prior to surgery.

This patient admitted that when he was undergoing orthodontics as a child, he was recommended to remove his third molars due to a lack of space.  Unfortunately, they elected to forget about it since it was “not bothering him”.  He waited until recently when his face became swollen and teeth became symptomatic.  This happens all too often, with patients delaying treatment until things become painful.  Pain is a sign of damage.  A lack of symptoms is not indicative that there is nothing wrong.  We have to go based on radiographic/x-ray findings.  A common analogy that I give to my patients is that many people that have cancer are completely asymptomatic.  But as soon as there is evidence of disease or some abnormality noted on an xrays or MRIs, then treatment is recommended.

Third molars are best removed in the younger years (<age 25), when the teeth are still premature and completely asymptomatic.  The post-operative recovery tends to be much less traumatic, with patients making a full recovery within 1-2 wks.  The older the patient and the further along the root development; the more difficult the procedure becomes for the patient both during and after the procedure.

Specifically on this patient:  this is his pre-operative panorex xray, with horizontally impacted third molars, with deep pocketing, loss of attachment and bone loss on the adjacent tooth (the second molars), with close proximity to the IAN canal, as depicted by the 2 parallel yellow lines on the lower R of the picture below:

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At this point we had no choice but to obtain a pre-operative CBCT in order to make sure the Inferior Alveolar Nerve (I.A.N) was not encased within the roots of the third molar.  On occasion, some patients question the need to obtain CBCT’s prior to surgery.  Without these imaging, you are just increasing your risk of complication, i.e. damage to the adjacent structures, i.e. arteries and nerves…  A CBCT provides us with very critical information on the proximity of the IAN and other vital structures at the site of surgery.  We would never ask a heart surgeon or a cardiologist to do surgery without the needed imaging such as a CT or a chest xray.  The same also holds true here.  See his CBCT below (the red line presents the IAN nerve):

 

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Since there was already deep pocketing and bone loss adjacent to the 2nd molar, this patient required bone grafting in order to improve the prognosis and longevity of the adjacent teeth.  See his post-operative panorex with the grafting material packed into the extraction sites in order to bring back at least some of the bone loss.  In these instance we may use a variety of bone grafting material, depending on the size of the defect and the damage to the underlying bone.

 

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If he would have just extracted his third molars when he was a teenager, the would not have required a CBCT, because the root of his third molars would still be premature and not close to the IAN.  (see below – a panorex xray of a third molar in a teenager that is still premature, in the “bud” stage)

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Additionally, if he would have just extracted his third molars when he was a teenager, the would not have required a bone grafting procedure, because third molar would have  still been encased in healthy bone without contamination of the surrounding area by the oral bacteria.

In summary, the older the patient when removing third molars; the more traumatic the procedure, the more expensive and the more the risk of complications.

 


Stem cells in oral surgery?

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In a recent article published in Translational medicine (Nov 2014), there is mention of stem cells being used to regenerate new bone in patient’s jaw bone to place dental implants. Stem cells help regenerate bone for dental implants

We have been using stem cells in my practice for the past 2 years to improve the quantity and quality of bone for implant placement.  This method is reserved for the more complex facial bone defects and is not used on a routine basis.  Patients that typically undergo stem cell augmentation are doing so in preparation for dental implant placement.  We have noted a greater amount of bone production and a higher quality (density) of bone during the implant placements.

This method is especially useful for patients with pneumatized (large) maxillary sinuses, that lack bone in the posterior of the upper jaw, requiring “sinus lifts”.  Below is patient that presented to me in 2012 for total rehab of her failing dentition.  She desired a fixed solution to her missing upper teeth and did not want a denture.  On her initial panorex, it is clear that she has large sinuses, without adequate bone to place any implants in the posterior of her upper jaw.  Hence she underwent stem cell grafting of her maxillary sinuses.  Please note the increase in bony height at the bottom of her maxillary sinuses.


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What’s In a Bone Graft

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The practice of bone grafting is nothing new. In fact, it goes back hundred of years to a time when a Dutch doctor implanted a dog’s bone into an injured soldier’s skull. The soldier later wanted it removed but it could not be removed, as it had bonded so closely to the bone. This brings up a very common question that we hear in our practice: What is a bone graft made of?

What the Dutch doctor didn’t know was that the implanted bone was likely resorbed by the patient’s body and replaced with his natural bone. This natural process is called “guided bone regeneration”, and it is one of the reasons that bone grafting has worked so well over time!

Naturally, patients are concerned about where their bone grafting material has come from. But in all cases, we stress that the material that we implant is not the final material that you will have in there. Bone grafting material is really just a place-holder, it encourages (and fools) your body into producing more bone in that site, and in the process resorbs the material that we have implanted.

Here are some common sources for bone grafts:

  • The skull, hip, and lower leg bones are very effective and common donor sites.
  • Tissue banks may be used when more bone is needed.
  • Shavings: If we drill into your jaw, naturally there will be shavings that are produced during the procedure, and often they make ideal bone grafting material!
  • Synthetic bone grafting materials.

It is natural to be concerned about what type of tissue we are implanting into your body! Please don’t hesitate to ask us questions about this or your other upcoming procedures.

All-on-4, 5, 6….which one is it?

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When patient present with a “terminal dentition”, meaning there is no hope of saving the teeth…we turn our attention to the “All-on-4” or 5 or 6 concept.  With the use of guided technology we are able to place multiple implant in the patient to give her a smile she has never had before.  She used to be so self-conscious about her appearance that she barely smiled.

With this concept we are able to provide the patient with a “fixed” solution, meaning that she will never need to remove the prosthesis and it is fixed to her jaw.  They feel like regular teeth, without the need to remove it like a denture.

This is a 1-week postop photo after performing an All-on-5 case on the patient.  Can you tell which jaw has the All-on-5 prosthesis?

This is what we started with:  Terminal periodontal disease with bone loss around 90% of her teeth.  The majority of them had severe mobility, grade III.

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This is what we ended up doing for her:  All-on-5 in the lower jaw.

Jennifer Liu postop pano 7-30-2015

 

Another life changing surgery.  Changing smile, changing lives.

Dry socket anyone?

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Dr Massoomi dry socket

 

Dry socket!

The most dreaded thing that most patients ask me during the consultation.  Everyone seemingly knows about dry socket.  What is dry socket?  Well, its really the inflammation of the bone in the extraction site, the bone that used to support the extracted tooth.  Typically when a tooth is extracted, a blood clot is formed in the socket, that acts as a “bandaid” to protect the underlying bone.  This blood clot will eventually reorganize, mature and turn into bone, if it is not dislodged.

Unfortunately, sometimes this blood clot becomes dislodged and the bone in the extraction site becomes exposed to all things that are typically found in ones mouth…saliva, bacteria, food….This becomes a setup for disaster and a petri dish for bacteria overgrowth, really irritating the bone and leading to severe pain….pain that is not even controlled with narcotic pain medications.  This is why everyone dreads this complication after extractions, especially after the extraction of third molars.

So how do we prevent this dreaded side-effect? I always tell my students to “bring the tissue back into harmony” meaning if there is an incision made or if the soft tissue is elevated in order to extract a tooth; then replace the tissue over the extraction site with stitches…to cover the hole, to prevent the dislodgment of the blood clot.  Additionally, for years I have been placing resorbable collagen in the sockets, to act as the so called blood clot, to prevent dry sockets.  Honestly, I have performed thousands of these procedure and I have had only one dry socket case in 10 years.  Why?  because I am preventing the dislodgment of the blood clot by closing up the extraction hole.  Patient recover faster, they have less pain and they rarely ever get dry socket.  It may take us longer to suture the sites and costs us more to place collagen in the extraction sites…but its so much better for the patient.

So is this just some voodoo medicine or is this based on scientific research…..

In the most recent edition of JOMS (Oral Maxillofac Surg 73:1457-1464, 2015), Dr. Cortell-Ballester and their team found that actually the use of resorbable collagen membrane after surgical extraction of mesioangular or horizontally impacted third molars, stimulates bone regeneration, improving the attachment level and bone fill distal to the second molars!  Also, it decreased the probing depth and results in faster recovery for the patient.

Amazing….We known this all along based on our clinical findings.  Glad to see someone is proving this for us!  Thank you.

The next time you have an extraction, wisdom tooth extraction….ask your doctor, are they packing the extraction site with collagen?  Trust me, it will only help your body recover faster and prevent the dreaded dry socket.  

The Miracle of Bone Grafting

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The Miracle of Bone Grafting

Why would I ever need this?
Let’s say you need a dental implant. You’re sick of that hole in your mouth where one of your teeth used to be, and you’re ready for a shiny new tooth to fill the gap. The problem is, your bone just isn’t strong enough to support the implant. Maybe you have periodontal disease, and the jaw bone is just too weak. Bone grafting may be necessary.

How does it work?
Simply put, bone grafting is the process of taking a little bone material from another site in your body and placing it where it is most needed. The healthy bone then fuses with the weak bone and encourages your body to grow more bone in the site, rebuilding the area to the point where it can support an implant.

There are a few ways to do this.
Sophisticated sounding terms to impress your friends:

  • Autogenous bone graft: Bone is removed from another site in your body and transplanted to where you need it. If you need just a little bone, it can be taken from another site in your mouth. But if there is not enough good material in your mouth, or you need a sizable amount, it can be taken from your hip, or your shin.
  • Allograft: Synthetic bone can be grown in a lab, or taken from a cadaver bone. This is a perfectly safe, proven procedure, though your best bet is always your own bone material. Your body knows there’s just no place like home.
  • Xenograft: Cow bone. Yes. Your body will accept cow bone. In this scenario, no secondary donor site is needed, so it may be a great option if you are uncomfortable with having bone taken from another site in your body. This is a perfectly safe procedure. Your jaw can be beefed up with bovine bone.

No online article will let you know for sure whether or not you need bone grafting, but it is good to know something about it. Give us a call and come on down for a consultation, and we’ll let you know exactly what we think the best option is for you.

Modern Options for Bone Grafting Technology

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ModernOptionsForBoneGraftingTechnologyBones, grafting, or any combination of the two are rarely the subject of casual conversation. Most of us, regardless of our profession, are happier discussing recent football scores, the price of gasoline, or the abnormally high number of Dunkin Doughnut franchise locations. Perhaps for it is for this very reason, however, that we should bring up this important topic–to raise awareness, maximize modern technology, and inform the public about the options offered in terms of dental implant surgery.

Bone grafting for dental implants is the process by which bone tissue is placed (grafted) into the mouth to act as a placeholder for tissue that has been lost. In the modern medical landscape this is a safe, painless, and routine process: indeed, more than two million bone-grafting operations occur worldwide each year, making bone the second most transplanted organ (after blood!).

As well as natural bone tissue, synthetic tissue is an alternative for patients seeking the best results. Structured as a ‘biodegradable scaffold’ that can be implanted within the body and trigger bone regeneration, this strong, flexible material has been compared to tire rubber! Dr. Karin Hing, author of the study and reader in Biomedical Materials at Queen Mary’s University of London Institute of Bioengineering stated that the challenge being tackled currently is the development of a graft that is as clever as bone. By mechanically evaluating the way bone adapts to its environment and reacts to chemical and physical components, progress is taking place in leaps and bounds.

What does this mean for the average person who just wants to be happy with their mouth? Comfortable outpatient procedures complete with local anesthesia or intravenous sedation make bone grafting a sensible and worry-free choice. Browse our procedures page for more information on maximizing your resources!

Pre-Implant Bone Augmentation

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Pre-ImplantSurgery

We are all unique, and so is your mouth! Sometimes, your jaw needs to be beefed up a little, and we’re not talking a hefty workout at the gym.
You may have lost teeth due to gum disease which has resulted in bone loss, or you could just have been “born that way” and need a little help expanding!

Don’t let life get you down! We’ve got these options for you;

Sinus Lift or Sinus augmentation:
A sinus lift is often performed on people who have lost teeth in their upper jaw or are lacking adequate bone density. This procedure adds bone between your jaw and the maxillary sinuses (which are on either side of your nose), the area of your molars and premolars. To make room for the bone, the sinus membrane has to be moved upward, or “lifted.”
The new bone means implants can be placed. This procedure does not affect speech, intonation or cause sinus problems.
Sometimes this procedure is required in the alveolar ridge. The alveolar ridge is the part of the gums immediately behind the upper front teeth. Alveolar ridges contain the sockets, or alveoli, of the teeth. You can feel it on the upper palate if you say words like “tight”, “dawn” because the consonants are made with the tongue tip or blade reaching for this alveolar ridge.

Ridge Expansion or modification: If your jaw isn’t wide enough to support dental implants, bone graft material can be added to a small ridge, or space that is created along the the jaw. Malformation in the lower jaw can result in not enough bone to place dental implants and it can also cause an unattractive indentation in the jaw line near the missing teeth that may be difficult to clean and maintain.

During ridge expansion, the bony ridge of the jaw is increased and bone graft material is inserted and allowed to heal before placing the implant.
Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come. It can enhance your restorative success both aesthetically and functionally.

Whether you require a lift or expansion, the bone usually will be allowed to develop for about four to 12 months before implants can be placed. However, in some cases, the implant can be placed at the same time the ridge is modified.

What are you waiting for? Ask us today what your implant options can be!


Types of Jaw Surgery

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TypesOfJawSurgery

Your jaw consists of two parts; the maxilla or upper jaw and the mandible or lower jaw . Sometimes these are misaligned and need to be put back into place for bite reasons, or for aesthetic purposes. Corrective jaw surgery straightens or aligns the jaw, and is often referred to as “orthognathic” surgery; “orthos” meaning to straighten and “gnathic” relating to the jaw.

There are a few different types of jaw surgery, depending on which part of your jaw requires correcting;

Maxillary Osteotomy (Upper Jaw)
This type of surgery corrects a significantly receded upper jaw, cross bite, or when you have too many or too few teeth showing. It also can adjust an open bite.

Mandibular Osteotomy (Lower Jaw)
This surgery corrects a significantly receded lower jaw. The surgeon moves the jawbone forwards or backwards depending on the best adjustment and bite alignment.

Genioplasty (Chin)
A deficient chin often accompanies a severely receded lower jaw. Typically, surgeons can alter the jaw and restructure the chin during the same surgery.

Once your jaw is aligned, tiny screws and plates hold the bone into position. These screws and plates are osseo integrated and are specially formulated to be compatible with your body. They become integrated with your bone over time and do not have to be taken out.

Extra bone can also be added to your jaw if there is insufficient bone. This can be grafted from your hip, leg, or rib.

Often these types of jaw surgeries are performed entirely inside the mouth without any evidence on the skin surface as to what procedure has been performed. There are no facial scars on the chin, jaw or around the mouth.

Often with extensive jaw surgery, the process is carried out after you have had braces, so your teeth are aligned and ready for your jaw to be moved. Braces are placed anywhere from 9 to 18 months before jaw surgery.

Jaw surgery can take up to 2 years to complete, but the results are for life! Know your jaw facts; Talk to us today to discuss your options!

3D Printers and Bone Grafting

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There is exciting news in bone grafting technology that will hopefully find its way into the oral surgeon’s office over the next decade! Researchers have been able to create a synthetic bone material using 3D printers that may be better than what is being used now. '3D printed bone graft'

3D printers create three-dimensional objects out of a variety of materials using a computer as a precise guide. Although the concept has been in the news a lot recently, the practice actually dates back to before the 21st century. In fact, 3d printing’s roots go back to the early 1980s. Since then, everything from jewelry to synthetic human organs has been printed, much to the amazement of modern society!

And now, surgeons have successfully implanted the 3D-printed synthetic bone grafting material into animals with bone defects. This “hyperelastic bone” was made using just the right combination of bioactive materials and polymers to make a material that could be layered while still wet, allowing for better adherence between layers.

Here are some of the expected benefits of this new material:

  • Very elastic, allowing for cutting without crumbling, which can be a problem with current grafting materials.
  • Blood vessels move in quickly because the material is porous.
  • Biodegradable as the body replaces it with genuine tissue.
  • Doesn’t dry out right away.
  • So far the animals haven’t rejected the implant, which could mean less complications for humans as well.
  • Could be a great option for children since it will grow with them.

While human trials are potentially five or more years away, the news is very exciting for the surgical community, and we are can’t wait to see what benefits this will bring to our patients.

To find out more about bone grafting in general or to set up a consultation with our office, please call us at San Francisco Office Phone Number 415-813-6400 .

Autograft vs Allograft

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'woman smiling after receiving bone graft'So, you were recently told by your doctor that you need a bone graft, but you aren’t quite sure what that means.

A bone graft is a surgical procedure that is used to fix bones or joints that were damaged by trauma, and it is also used to replace bone that is missing to provide structural stability around the body, including the jawbone. There are many types of bone grafts we can use to grow bone – the two most common are autografts and allografts.

An autograft is a bone or tissue that is transferred from one spot to another on the patient’s body. It is often thought of as the “gold standard” in bone grafting because of its reliability. Its high success rate is due to the fact that it is living tissue and thus its cells are kept intact.

An allograft is a bone or tissue that is transplanted from one person to another. They typically come from a donor, or cadaver bone. The allograft is safe, ready to use and available in large amounts. The main advantage of an allograft is that it requires one less procedure than the autograft, which must first be taken from the patient. Surgical time is minimized and the recovery can be quicker. The allograft comes from a reputable and reliable tissue bank.

Knowing which bone-grafting option you will need can be confusing, but we are here to answer any questions you may have. Please schedule a bone grafting consultation with us by calling San Francisco Office Phone Number 415-813-6400 . We will perform a thorough evaluation of your oral health. After our evaluation, we will recommend what bone graft is best for you. We are happy to discuss your options and answer any questions you may have. We want you feeling confident with our choice and worry free.

Bone Grafting for Dental Implants

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Bone grafting and dental implants typically go hand-in-hand, as the loss of a tooth can wear down the surrounding jawbone structure and a dental implant is a common procedure toreplace lost teeth. As soon as a person loses a tooth, bone loss begins. In order to place a sturdy, reliable dental implant, bone grafting procedure is often required in order to rebuild the jawbone. While bone grafting sounds daunting, it is a safe and reliable procedure that prepares the jaw bone for a dental implant, and in most cases, is necessary to build up a sturdy foundation.

In a bone graft procedure, bone tissue taken from another part of the body is grafted into the jawbone. Another method utilizes processed bone from animals, but results in the same regrowth of your jaw. It can take several months for the graft to set and grow into a stable foundation for a dental implant.

Depending on the amount of bone loss, bone grafts can be placed at a variety of times during the implant process. For example, if only a minor bone graft is needed, we may be able to place it at the same time as the dental implant. However, if a larger bone graft is necessary, it will have to rest for months before the dental implant procedure can be performed.

Bone grafting is a very important and often overlooked procedure when it comes to preparing for a dental implant! Dental implants have increased in popularity and effectiveness over the years, as they provide the most reliable replacement for natural teeth. Dental implants look and feel like normal teeth, and if treated properly, can last the rest of a person’s lifetime! Bone grafts and dental implants work together to restore smiles.

Contact us today at to schedule your dental implant consultation, and we can talk about your bone grafting options!

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Jaw Surgery in San Francisco

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Some times corrective jaw surgery, or otherwise know as “orthographic surgery,” may be necessary when a patient’s jaws do not fit together properly.  This misalignment can cause issues with activities as common as chewing food or speaking. They can also cause headaches due to clinching and grinding, and even sleep apnea, a condition in which a person periodically stops breathing during the night.

Although most of the time jaw surgery is an “elective” surgery, at time it can be medically necessary.  Jaw surgery can involve both the upper and lower jaw, or just one of the jaw; a times it can also involve just the chin (genioplasty).

Jaw surgery should only be done when the patient has completely stopped growing.  Since most jaw surgeries requires pre-operative orthodontics to align the teeth, the cessation of growth is usually verified by a good orthodontist using a hand /wrist X-rays OR by comparing two lateral ceph X-rays.  Although the cessation of growth usually occurs around age 15 years for girls and 18 years for boys; the only way to know for sure it is required to take those two types of X-rays.  Timing is everything…if jaw surgery is performed before the cessation of growth, then the jaws will become misaligned again requiring another surgery in the future!

If a patient’s jaw problems are identified early in life, and properly treated, the need for surgery on can be avoided later in life.

Some consider corrective jaw surgery as “cosmetic surgery” since it can improve the appearance of the patient’s face.  It can make a person’s face appear more “full”  or a create a more masculine look in males, especially if the surgery involves the chin.  Lastly, corrective jaw surgery can improve chewing and reduce the incidence of sleep apnea.  For more information about jaw surgery please call our office to schedule a consultation.

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Bone Grafts in San Francisco: A Necessary First Step

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We know that dental implants can transform your life.  Implants are designed to replace the gap in your smile with a natural tooth.  In some cases if multiple implants are used, you can replace all of your teeth in a procedure referred to as “All-on-4”.  So now you can now have an artificial tooth that looks natural and functions like a natural tooth.

Unfortunately, the most common thing that we see in our offices on a daily basis is the LACK OF BONE to place an implant.  You have to think of enough bone in a 3-dimensional view.  There has to be enough bone in all 3-dimensions in order to place an implant: width, height and depth.  So if any patient lack bone in any of these dimensions, then a bone grafting procedure is needed before the implant can be placed.  This lack of bone in the 3-dimensions is usually because of the following reasons:

  1. EXTRACTION WITHOUT BONE GRAFTING. This is the reason why we ALWAYS tell patients that if you are going to have a tooth extracted AND are thinking of replacing it with an implant ALWAYS ask about bone grafting.  Do not let anyone remove your tooth without bone grafting.  To us it does not matter who does the extraction + bone grafting, we just want you to have enough bone, just in case you decide to have an implant in the future.
  2. SUBOPTIMAL BONE GRAFTING. Sometimes we have patients that are referred to us for implants after having their tooth extracted + bone grafting by other practitioners. Unfortunately, despite the bone grafting there is still not enough bone to place an implant.  This can sometimes be because of the following: inadequate/incorrect bone grafting material, lack of exposure at the site, lack of securing the bone grafting material and lack of isolation.  A bone grafted site almost always needs to have three vital materials: the right bone grafting material, the isolation of the site using a “membrane” and closure of the site with sutures.  This is why anytime you have a bone grafting procedure you are quoted for “bone grafting” (there are many different types of bone grafting) and some sort of “membrane” (there are many different types of membranes).
  3. An extended period of time between the time of extraction and the implant placement.  When a tooth is lost or extracted the underlying bone undergoes remodeling.  Over the years the underlying bone will shrink, causing a lack of bone at the site of the missing tooth for an implant placement.  Additionally, if there is an infection around a tooth, which is usually the case, then infection will also destroy the underlying bone.  The most common area that we see is at the first molar site, usually referred to as the “6th year molar” because these teeth come in around the age of 6 and are exposed to all the candy, soda and all the detrimental agents that cause cavities on our teeth.  This is the most commonly extracted tooth in adults.

When a patient presents to us for an implant, we usually obtain an xray first, to determine if there is enough bone to place an implant.  The most common xray is a “panorex” a panoramic xray that allows us to see the vital structure in your face (sinuses, nerves, arteries…).

Above: “Panorex” – a panoramic x-ray

This xray is different from what is obtains at your general dental office, usually referred to as a “PA” this xray will only show your teeth and not the surrounding bone and vital structures.

Above: “Pa” – Periapical x-ray

Subsequently, if there are any questions about the adequacy of the bone on the panorex, (especially in the width dimension), then a CBCT may be obtained in our office to visualize the site in 3-dimensions.  Unlike most dental offices, we have a special softwares in our office that allows us to virtually perform you implant surgery using the CBCT data = “virtual implant surgery” even before going into surgery.  This allows us to measure the needed distances so sub-millimeter accuracies and to show you exacting what is and what is not possible, with or without bone grafting.

Above: CBCT – 3D Views of the implant in virtual planning

As mentioned earlier, it is not uncommon for people who are missing a tooth to have bone loss at the site of the missing tooth.  Over the years, when a tooth is missing, the body starts to reabsorb the jaw.  We need at least 2mm of bone all the way around the implant.  Since the smallest implant that is manufactured is 3.0mm, we need at least 2mm + 3mm implant + 2mm of bone to place an implant.  That means you need to have at least 7mm of width at the site of your missing tooth for an implant.  Additionally you need to have a minimum of 2mm distance between natural teeth and an implant.  Meaning that you need a 7mm distance between your missing teeth in order to have an implant.  If this space is not there, then you will need to undergo orthodontics to open up 7mm of space before an implant is placed – we have many patients  that have to do this especially if they have never had orthodontics in their childhood.  This is why it is highly recommended that you replace a missing tooth between other teeth, before the adjacent teeth shift into that space.

Over time, if there is not enough around the implant, the implant surgery may fail.  This is another common phenomenon seen in our office, where patients are referred to us for implants that are failing and need to be removed.   It is much hard to remove and implant then to replace it!

Let’s say that we have determined that there is not enough bone for an implant and that bone grafting is required before any implant placement.  Bone grafting comes in many forms.  It can be synthetic, from other animals, humans, stem cells or from yourself.  The basic makeup of all these materials is calcium.  By providing this additional material at the site of the missing tooth, your bodies bone cells (osteoblasts) will use this added calcium to create new and more bone at the site.

Afterward, it usually takes a few months for the grafted material to be strong enough to place an implant into the newly generated bone.  This is why X-rays are taken a few months after the bone grafting procedure to visualize what has happened at the bone grafting site.  If the X-rays show that the bone density at the site is suboptimal, then more time will be required for the bone  to regenerate and re-calcify before placing the implant.

In all of our locations in San Francisco and Cupertino, we recognize bone grafting is sometimes a necessary first step toward a successful dental implant.  Call us today for a consultation to find out more about your bone grafting options.

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Sinus Lifts and Dental Implants

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If you have dentures or a missing tooth that was extracted many years ego, dental implants can be transformative in many ways.  Dental implants are designed to replace and function just like a natural tooth.  But before you can get a dental implant, it is essential that you have enough bone to act as the foundation for the dental implants.  This is where being an INFORMED PATIENT is so critical.

On a daily basis we have patients that contact our office desiring dental implants.  They usually had a tooth that was extracted – WITHOUT bone grafting, either recently or many years ego.  This only means that the patient will most likely lack sufficient bone to place an implant.  Subsequently a bone grafting procedure will be recommended if there is any hope of getting dental implants.

When it comes to bone grafting, the backside of the upper jaw can be especially challenging because of our natural facial anatomy.  Unknown to most people, our maxillary sinuses are right above our back (Molar) teeth, naturally leaving less bone to work with when the teeth are extracted.

So anytime a patient has a molar tooth extracted, the bone will naturally reduce in its amount during the healing process.  This is why bone grafting is almost always recommended in the upper jaw in order to conserve as much as bone as possible for an implant and to also prevent a permanent hole that we usually refer to as an OA-fistula (Oro-antral fistula).  If there is any need for the bone grafting procedure to go into the sinus cavity, this is referred to as a “Sinus Lift”.  However, what most people do not know is that sinus lifts can be done in two major ways: External and Internal.

1. External sinus lift: is reserved for more extensive bone loss, resulting from multiple missing molar teeth in the posterior of the upper jaw for many years.  This is especially true if the teeth were extracted without any bone grafting.  See Panorex x-ray below with multipe missing teeth in the upper jaw.  The maxillary sinus cavity is noted with blue arrows and the thinning of maxillary bone high-lighted in yellow.

In this case, we performed an External Sinus lift approach commonly referred to as a “Caldwell Luc” approach, from the outside of the maxillary bone.  See below:

This patient underwent bilateral sinus lift using Stem Cells to generate enough bone to place multiple dental implants to replace all her missing teeth in the upper jaw, commonly referred to as the “All-on-4” implants.  The Panorex below demonstrates the increase in bone as noted by the high-lighted yellow, as compared to the previous Panorex in the same patient.

The same patient with 5 implants in the upper jaw.

Same patient with hybrid teeth loaded on the 5 implants.

  1. Internal sinus lift: is usually done to prepare an extraction site for a single implant in the posterior region of the upper jaw (molars and sometimes premolars). This is usually done at the same time as the extraction, reducing the total treatment time by 50% by avoiding an additional bone grafting surgery in the future. This is why it is HIGHY recommended that bone grafting is performed anytime a tooth is extracted, especially if an implant is desired in the near future.

DO NOT LET ANYONE EXTRACT A TOOTH WITHOUT BONE GRAFTING, ESPECIALLY IF YOU WANT AN IMPLANT IN THE FUTURE.

In the case below a patient presented with an infected molar tooth #3 in the upper right side – as noted by the blue arrow.  This tooth could not be saved despite two previous root canals and his general dentist and endodontist recommended an extraction and replacement with an implant.  In this case the patient elected for an internal sinus lift, due to a lack of bone as noted by the yellow lines.

During the extraction procedure, through the same extraction site, the bone was impacted up using an osteotome (red arrow) and then the remaining space was bone grafted and covered with semi-permeable membrane and sutures to protect the grafted site.  Over the next 4-6 weeks the sutures and membrane are removed.

Once the sinus lift is complete, you’ll have to wait a few months for the new bony material to harden and integrate with the existing jaw bone, referred to as “osseointegration”. Subsequently, dental implants can usually be inserted 3 – 6 months (or longer), after the sinus lift.  The quality and quantity of bone is confirmed using either a panorex or a 3D CBCT before the implants are placed.

If you are tired of your loose dentures and are interested the “All-on-4” implant concept, or just have a missing tooth; give us a call at 415-813-6400 in downtown San Francisco or 408-253-6081 in Cupertino.  We look forward to improving your smile!

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Everything you need to know about Dental Bone Grafting

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Everything you need to know about Dental Bone Grafting

What exactly is a bone graft?: Bone grafting is a surgical procedure done when you need to repair bone fractures or replace bone loss. When a tooth is missing or retracted from the alveolar bones that support your roots, gums and teeth, it eventually evaporates, causing facial features to shift and sag over time. This then creates potential problems such as pain in your mouth, not being able to speak properly, or chew food adequately. Fortunately, with the help of bone grafts, the bone that has been lost can be built again, which will not only heighten your appearance by providing strength back into your jaw bone, but also allows us to place a dental implant (artificial tooth) on top of it! In simple terms, the goal of bone grafting is to provide a safe, long-term solution to tooth loss!
How it works: The procedure itself is done by using a piece of bone (typically from your own jawbone; however artificial is also an option) as the base for your implant. Depending on the type on dental implant you plan on the receiving, and the condition of your jawbone, the process of recovery can take up to several months for the transplanted bone to grow enough to fully support the implant. Once the jawbone is healed, titanium, screw-like posts act as the new implant’s roots for fully functioning tooth support. The final step of dental bone grafting is to make molds of your teeth and jawbone, which will then follow with the placement of your realistic-looking artificial tooth!
After The Procedure: Bone grafting is a very popular and safe procedure, with over two million surgeries being reported each year. Of course with any surgery, come a few risks. Common ones include infection at the source, damage to the surrounding teeth or blood vessels, nerve damage, and sinus problems. The post-procedure discomforts include swelling of the gums, brushing on the skin, and minor bleeding. Any discomfort after the procedure should only last a few days and can be managed with anti-inflammatory medication, as well as ice therapy.
Following a successful bone grafting and implant surgery, it is recommended to practice excellent oral hygiene and see your dentist regularly to ensure proper functioning of your implant! To learn more about bone grafting or think you are a qualified candidate to have it done, give us a call at [PHONE]!

The post Everything you need to know about Dental Bone Grafting appeared first on Dr. Nima Massoomi DMD MEd MD.

Dental Implants and Bone Grafting

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Before you can get a dental implant from Bay Area Surgical Arts in San Francisco and Cupertino, we have to make sure you have enough health bone in your jaw.

Plenty of healthy bone is essential, because it provides the support and stabilization required for a successful implant.

A dental implant is a titanium post that goes directly into the jaw, where it replaces the root of the missing tooth. Titanium is especially well-suited for this, because it fuses so well with human bone. But first, we have to be sure there is enough.

A bone graft involves transplanting bone from another part of your body to the jaw. The hip is a common source. However, artificial bone can also be used.

It takes a couple of months for the graft material to grow new bone. Once we have determined there is enough bone mass, we can move forward with the dental implant.

Dental implants are an unbeatable solution for anyone missing one or more of their natural teeth. Bay Area Surgical Arts offers single and multiple dental implants, plus implants for full dental arches. We have offices in San Francisco and Cupertino. Call one to ask about bone grafting, and schedule an appointment today!

Bay Area Surgical Arts

San Francisco: 415-813-6400
Cupertino: 408-253-6081

The post Dental Implants and Bone Grafting appeared first on Dr. Nima Massoomi DMD MEd MD.

Modern Options for Bone Grafting Technology

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ModernOptionsForBoneGraftingTechnologyBones, grafting, or any combination of the two are rarely the subject of casual conversation. Most of us, regardless of our profession, are happier discussing recent football scores, the price of gasoline, or the abnormally high number of Dunkin Doughnut franchise locations. Perhaps for it is for this very reason, however, that we should bring up this important topic–to raise awareness, maximize modern technology, and inform the public about the options offered in terms of dental implant surgery.

Bone grafting for dental implants is the process by which bone tissue is placed (grafted) into the mouth to act as a placeholder for tissue that has been lost. In the modern medical landscape this is a safe, painless, and routine process: indeed, more than two million bone-grafting operations occur worldwide each year, making bone the second most transplanted organ (after blood!).

As well as natural bone tissue, synthetic tissue is an alternative for patients seeking the best results. Structured as a ‘biodegradable scaffold’ that can be implanted within the body and trigger bone regeneration, this strong, flexible material has been compared to tire rubber! Dr. Karin Hing, author of the study and reader in Biomedical Materials at Queen Mary’s University of London Institute of Bioengineering stated that the challenge being tackled currently is the development of a graft that is as clever as bone. By mechanically evaluating the way bone adapts to its environment and reacts to chemical and physical components, progress is taking place in leaps and bounds.

What does this mean for the average person who just wants to be happy with their mouth? Comfortable outpatient procedures complete with local anesthesia or intravenous sedation make bone grafting a sensible and worry-free choice. Browse our procedures page for more information on maximizing your resources!

The post Modern Options for Bone Grafting Technology appeared first on Dr. Nima Massoomi DMD MEd MD.

Dental Implants and Bone Grafting

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Before you can get a dental implant from Bay Area Surgical Arts in San Francisco and Cupertino, we have to make sure you have enough health bone in your jaw.

Plenty of healthy bone is essential, because it provides the support and stabilization required for a successful implant.

A dental implant is a titanium post that goes directly into the jaw, where it replaces the root of the missing tooth. Titanium is especially well-suited for this, because it fuses so well with human bone. But first, we have to be sure there is enough.

A bone graft involves transplanting bone from another part of your body to the jaw. The hip is a common source. However, artificial bone can also be used.

It takes a couple of months for the graft material to grow new bone. Once we have determined there is enough bone mass, we can move forward with the dental implant.

Dental implants are an unbeatable solution for anyone missing one or more of their natural teeth. Bay Area Surgical Arts offers single and multiple dental implants, plus implants for full dental arches. We have offices in San Francisco and Cupertino. Call one to ask about bone grafting, and schedule an appointment today!

Bay Area Surgical Arts

San Francisco: 415-813-6400
Cupertino: 408-253-6081

The post Dental Implants and Bone Grafting appeared first on Dr. Nima Massoomi DMD MEd MD.

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