Bone grafting options

There is a lot to bone grafting for dental implants. This video should give you a great starting point to learn more about the many options and reasons for bone and gum grafting.

Hello, I'm Dr. Ramsey Amin, bone grafting is a really important part of implant dentistry because having enough bone around an implant is like having enough concrete around a post that holds your house up. So it's certainly important to have the right amount of bone. Always extra actually is a good thing because it tends to melt away overtimes. There are some really neat techniques for bone grafting, the technique and the skill and judgment of bone grafting it's an art that's mastered over time. It's not something, it's not about products and what you use and what brand of a bone, or if you use your own bone or synthetic bone. It's really about the way that it's done is really how it's going to become successful long-term. Did you know that bone can actually melt away over time? So you can graft the bone back then it actually shrinks over time.
So the technique and having this done right, the first way is really, really important. I do many different kinds of bone grafts. Sometimes I'm building the bone to be wider because it's too narrow. Sometimes I'm building it to be taller. Sometimes you've got to build it to be both, tall and wide. Sometimes it's to fix a dent on the outside part of the jaw so it looks better and sometimes it happens internally like inside the sinus, where it's a hollow space to place an implant into that you need bone to put into hollow areas. So even though there's different types of bone, your own bone, bone from a tissue, donor that's a human being, bone from a cow, or bone that's completely synthetic. It's the techniques that are used. In fact, I use all of them, synthetic, not too much at all and my least favorite doesn't really convert into real bone, but there's different techniques, about 20 different techniques I do.
Some are taking a titanium tray, we call it titanium mesh to build bone, to hold it in place. Some are called block grafts where I'll take a piece of bone from here or from your chin and transplant it to different areas with screws and membrane techniques. That's called GBR where a membrane can be exposed, or it could be put underneath to help keep the bone in and the gum from growing down inside of it. Most bone grafts can be helped by repositioning the gum to a better place kind of borrowing part of the gum from the inside to the outside or transplanting gum from the roof of the mouth into areas that are deficient. Because having gum is just as important as having bone around an implant, especially for longevity, because as you know, about 30% of what I do is replace failing implants.
Oftentimes there's just not enough gum around them or not enough bone to begin with. For most patients, the bone grafting is done simultaneously with the implants. On more advanced cases, I'll have to do it beforehand as separate procedures. Typically you're sedated for them, give them some special anti-inflammatory and steroids, an injection in the shoulder mixing some of your blood product from your arm, that's called platelet-rich fibrin in order to make the bone graft heal better. It's really important the techniques that are used, how your temporaries are, are you without teeth the whole time? Do you have immediate teeth? What if something presses on it? These are all things that I will go over with you in the many different types of techniques that we do. The most common technique that I do is called a socket graft. That's just removing a tooth and putting bone into the socket.
But again, I see a lot of times where people come to me after failed socket grafts. To me, the bone should be hopefully a one and done. Many people will travel to see me and my team from actually around the country, even during COVID to build back really extreme amounts of bone loss. Oftentimes I'm using your own bone and making little sections of it to build back areas that are really extreme bone graft loss. Sometimes I have to move the nerve from one spot to another, take the... It's called a nerve reposition. There are ridge augmentations, sinus lifts, titanium mesh. There's just a variety of ways and it's done at the same time of the implants, and sometimes just packed around the implants as well. There's specialized suturing techniques. Again, the bottom line is you want a great tooth that's going to function well and not have problems short-term or long-term infections.