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Bone Graft and Tissue Transplantation in Dental Implants

Mark D. Dublin

Definition of Terms

Dental implant - is a "root" device, usually made of titanium, used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth. Bone grafting - is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly. Transplantation - to transfer (tissue or an organ) from one body or body part to another. Gingival graft - is a generic name for any of a number of surgical periodontal procedures whose combined aim is to cover an area of exposed tooth root surface with grafted oral tissue.

Bone Graft
Bone

grafting is the most common surgical dental procedure associated with dental implants. It is vital that dentists placing dental implants be proficient at bone grafting techniques or knowledgeable enough to diagnose them and refer the patient to an oral surgeon to have that particular procedure done. most important requirement for a successful dental implant and bone grafting procedures is the presence of enough bone height and width to support the implant.

The

The most common use of bone grafting is in the application

of dental implants, in order to restore the edentulous area of a

missing tooth.

Dental implants require bones underneath them for support and to have the implant integrate properly into the mouth. People who have been edentulous (without teeth) for a prolonged period may not have enough bone left in the necessary locations.

In this case, bone can be taken from the chin or from the pilot
holes for the implants or even from the iliac crest of the pelvis and inserted into the mouth underneath the new implant.

Types of dental bone grafting procedures related to dental implants

Socket preservation Ridge augmentation

+ Socket preservation is where the bone is placed in the tooth

socket after extraction to preserve the height and width usually for future dental implant.

+ Ridge augmentation refers to the process of rebuilding the

height or width of the jaw bone or both to allow for a future dental implant. This procedure is usually performed in areas with considerable bone loss.

Connective tissue and mucosa tissue transplantations

used in dental medicine to treat gum tissue deficits especially in

those areas connected with aesthetics.

In contrast to a mucosa transplant connective tissue

transplantation also includes transplanting the subcutaneous

connective tissue.

The volume of the connective tissue transplant remains stable after the transplant and does not shrink. Therefore, it is commonly used to fill out areas with thin or little gum tissue.

Typical Indications for Mucosa Transplantation

Root exposure after recession (gum tissue recession)

Filling out and forming of jaw area which have deteriorated while also providing an aesthetic treatment

During a vestibule plasty which is used to increase the size of the oral vestibule

Periodontal Tissue Grafts

Periodontal gum tissue grafts are an important part of implant dentistry. There is two types gum tissue around teeth. Thick gum tissue immediately surrounds teeth and is referred to as (keratinized gum tissue) or (non-mobile gum tissue) or (keratinized gingiva) and thin tissue that lies close to the floor of the mouth that is referred to as (non-keratinized gum tissue) or (mobile gum tissue) or (non-keratinized gingiva).

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This

thick tissue is vital to the health and longevity of teeth. Loss of the thick keratinized tissue is referred to as gum recession or gingival recession. When that happens, the lost tissue must be replaced. Loss of keratinized tissue is common with dental implants as it is a common consequence of tooth loss.

Methods and materials utilized in tissue or gum grafting

Connective tissue grafts

Free gingival grafts AlloDerm tissue graft

Periodontal tunnel grafts or periodontal tunneling surgery

Growth Factors PDGF and Periodontal Tissue Grafts Placental tissue for periodontal tissue grafts

Connective tissue grafts

The graft is taken from the deeper tissue of the roof of the mouth and grafted to the deficient site.

Free gingival grafts

The grafted tissue is taken from the outer surface of the roof of the mouth and grafted to the deficient site.

AlloDerm tissue graft

AlloDerm is donated skin Allograft material from other humans that is processed to produce a dermis layer the deeper layer of the skin. The main advantage of AlloDerm grafts is less healing as there is no donor site at the roof of the mouth.

Periodontal tunnel grafts or periodontal tunneling surgery

Grafting gum tissue with tunneling techniques is a part of the

latest development in periodontal gum microsurgery techniques also referred to as periodontal plastic microsurgery. It is well understood that less invasive surgery would lead to less disruption to blood supply and in turn faster wound healing and more predictable results. Several variations of this method have been developed, these methods are referred to as modified periodontal tunneling surgery or modified periodontal tunnel grafts.

B e f o r e

After

Growth Factors PDGF and Periodontal Tissue Grafts

In certain cases growth factors can be used along with gum grafting. The most utilized is PDGF platelet derived growth factors. PDGF can promote the regeneration of periodontal tissue and healing. There are several techniques utilized in incorporating PDGF growth factors into periodontal tissue grafts.

Placental tissue for periodontal tissue grafts

The most recent innovation in periodontal and gum tissue is the utilization of placental tissue. It is thought to produce less inflammation than other donated allograft materials currently used.

Before Sinus lift

Sinus lift and dental implants placement

Sinus Lift

Sinus Lift is the process where the sinus membrane is repositioned to allow for a space where bone is grafted to support a dental implant. Sinus lift is a very predictable procedure that can increase bone height and width. In most cases the dental implant(s) is placed along with the sinus lift procedure.

Types of Bone Materials Used In Dental Bone Grafting

1. Autografts:
2. Allografts: 3. Xenografts: 4. Alloplasts:

Autografts

The bone comes from the same patient person, while the recipient site is the jaw, the donor site can be part of mandible or hip.

Allografts

Bone that comes from other humans, usually processed cadaver bone in the form of small granules or small blocks.

Xenografts

Bone from another species, most commonly from cows

Alloplasts

Synthetic bone material. Material that is manufactured.

Bone Grafting Is Not Appropriate

If dental implant bone grafts, bone growth, or bone expansion will not
provide sufficient support for a dental implant, the patient may have to have a mold taken of his or her jawbone and a plate inserted to hole the implants.

If you have plenty of bone tissue and the gums and teeth surrounding the area where you want a dental implant are healthy, then you may

not have to concern yourself with dental implant bone grafts