Guided Bone Regeneration, Bone Augmentation

As a result of tooth extraction, dental infection, trauma and post-operative bone resorption, it would be necessary to reconstruct or augment the bony ridge defect prior to or at the time of implant placement to ensure that there is sufficient bone around the implant. Both the function and the aesthetics of the teeth can be severely distorted if the supporting bone is lacking. Without enough intact bone, it is impossible to replace a lost tooth with an implant. Therefore, the alveolar ridge may need to be restored to assure a long-lasting and stable tooth replacement.

For minor bone irregularities, guided bone regeneration may be used. This involves the use of a membrane as a barrier to isolate the area where the bone is required. The barrier prevents other cells from growing in and enables bone cells to form bone. This technique may be used with an implant, a bone graft or by itself.

Guided bone regeneration or bone augmentation is used when it is necessary to rebuild bone in the jaw area. For this procedure we use a number of materials including animal-derived and synthetic products, sometimes your own bone or a mixture of all three, depending on the amount of bone required and how we wish to use it.

Bioceramics or bioglasses are ceramic materials which are biocompatible inert material which can be replaced by native bone after a definite material-specific resorption period and following the bone turnover. It has nearly the same structure as your own bone and functions as a guide-rail or tissue scaffold. The material is placed into the bone defect in a small surgical procedure. 

These synthetic bone graft materials are made from tri-calcium phosphate which acts as a scaffold into which new bone can grow. Tri-calcium phosphate occurs naturally in your own bone and is resorbed by your body but during a short period of three to six months. The body recognizes these materials like bone, starts to grow into the material and then integrates it completely. The result is a newly formed bone. The graft material will resorb as your own bone grows into it. These materials are sometimes covered with a protective membrane which is derived from porcine (pig) or bovine (cow) or similar collagen sources. The membrane helps to keep the bone graft in position and also helps to prevent the graft from being rejected. After bone regeneration, the membrane is completely resorbed by the body.
For larger bony defects, bone can be taken from elsewhere in your body, such as the wisdom tooth area, the chin or occasionally the hip, and then transplanted into the desired site. A referral to a Maxillo-Facial surgeon could be required for this type of procedure. Please tell your dentist before signing the consent forms if you do not consent to the use of animal-derived graft and membrane products.

Augmentation procedures

You have currently lost bone from the region where the back tooth was removed. If this bone is not regenerated, you could develop gum recession around the neck of the implant which would result in the dark metal becoming visible. My intention is to examine this at the time of surgery and if necessary, I will build up the bone with a bone substitute material. Although this is often successful, occasionally bone grafts could develop problems such as infection or resorption and some may not take. If bone grafting is needed, you are more likely to get a swollen lip after the surgery. Treatment to resolve any problems could incur additional appointments and cost.

Bone Regeneration/Augmentation

As you have lost some bone following the past extraction, it may be necessary to build up, or augment, the bony ridge at the time of implant placement to ensure that there is sufficient bone around the implant. The ridge may need to be built-up with bone-substitute materials. These materials are discussed in detail on the page of this document titled Patient Information, Guided Bone Regeneration, and bone augmentation. Please read this section and let me know before signing this form if you object in principle to the use of any of these materials.

Significant contributing factors to the failure of graft material and dental implants

Poor oral hygiene
Neglected oral hygiene leads to an increased likelihood of implant failure, as surgery sites can easily become infected with plaque bacteria.
If you smoke, it is essential to note that research has shown that smoking more than doubles the rate of implant failure, in the short and long term. This is due to a reduced healing capacity of the soft tissues as well as the bone. Therefore, smoking should be stopped altogether, otherwise, you may risk losing your investment. This is a very important issue that you must take into consideration when you decide on the best treatment option for you.
Excessive alcohol consumption
Alcohol reduces the resistance of tissues to trauma, causes tissue dehydration and general compromsied healing. Therefore, you must not drink any alcohol 24 hours before, and 72 hours after surgery.
Gum disease
Research has also shown that individuals with a history of gum disease have an increased risk of implant failure and complications such as gum infections around implants.