Bay Area Oral & Facial Surgery
Oral & Facial Surgery
San Francisco CA

Bone Grafting


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Over a period of time, the jawbone associated with missing teeth atrophies or is resorbed. This often leaves a condition in which there is very thin bone of poor quality and quantity. This situation is not suitable for placement of dental implants. When this happens, many patients are not candidates for dental implant surgery.

Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and aesthetic appearance. There are several areas of the body that are suitable for attaining bone grafts. Bone grafts can be taken from inside the mouth, in the area of the chin or third molar region, or in the upper jaw behind the last tooth. When we use the patient’s own bone for repairs, we generally get the best results.

Sinus Lift Procedure

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have a thin membrane lining but nothing else in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the bone is very thin, it is impossible to place dental implants in this bone.

There is a solution and it’s called a sinus lift graft or sinus augmentation. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.

The sinus graft makes it possible for many patients to have dental implants place in the upper jaw when years ago there was no other option other than wearing loose dentures.

If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, the sinus graft surgery and implant placement can sometimes be performed as a single procedure. If not, the sinus augmentation will have to be performed first, and the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.

Ridge Expansion

Sometimes after teeth are removed, especially if many years have passed, the bone has been resorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge is too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means and an implant can be placed that might have normally have been too wide for the available bone.

Socket Preservation

In many cases, when an extraction of a tooth is planned and the patient is planning for a future implant, it is critical to preserve as much bone volume as possible. Dr. Tom, Dr. Silva, and Dr. Connelly know that after extraction of a tooth, the body naturally resorbs or “melts away” much of the bone that was holding the tooth over time. In adults, sockets do not fill in 100% with bone in most cases. If you need an extraction and are contemplating a future implant, we use commercially available bone graft material to fill in your extraction site. This bone is prepared from bovine sources and used to promote the patient’s own bone to grow into the repair site. It is quite effective and very safe.

These surgeries are performed in the office under local anesthesia or IV sedation. After discharge, bed rest is recommended for one day and limited physical activity for one week.

Pre-Prosthetic Surgery

The preparation of your mouth before the placement of a denture is referred to as pre-prosthetic surgery. Some patients require minor oral surgical procedures before receiving a partial or complete denture, in order to ensure the maximum level of comfort. A denture sits on the bone ridge, so it is very important that the bone is the proper shape and size. When teeth are extracted, the underlying bone might be left sharp or uneven. For the best fit of a denture, the bone might need to be smoothed out or reshaped. Occasionally, excess bone would need to be removed prior to denture insertion.

One or more of the following procedures might need to be performed in order to prepare your mouth for a denture:

  • Bone smoothing and reshaping (alveoloplasty)
  • Removal of excess bone
  • Bone ridge reduction
  • Removal of excess gum tissue
  • Exposure of impacted teeth

Dr. Tom, Dr. Silva or Dr. Connelly will review your particular needs with you during your appointment.