Most people plan for some amount of loss and trauma in life. No matter what’s done, external and internal factors impact us over time. In the case of oral health, this rings truer.
Those that take excellent care of their teeth still suffer loss from a sudden shot to the jaw from an accident. Those who have never seen so much as a bloody nose face periodontal disease and bone degeneration.
In either case, you’re fortunate to live in a time when replacing teeth is easy and effective. Even long term or sudden massive damage to the mouth is treatable with bone grafting and implants.
With periodontal disease on the rise, it’s important to know how your bone health affects your oral health and vice versa.
Bone Grafting Overview
Dental bone graft technology and techniques developed after implants. Implant technology goes all the way back to the Egyptians. Copper and wooden rods were used to attach animal teeth into the jaws of pharaohs and commoners alike.
To understand the bone grafting as a whole it’s important to build comprehensive knowledge. We’ll start with how bone loss in the jaw occurs and why it’s an issue. Then we’ll move on to the purpose of bone grafts and the process by which it’s done.
Finally, we’ll discuss how implants work and their relationship with bone density.
Causes of Bone Loss
Bones in the jaw don’t tend to suffer breaks like other bones. Most commonly the jaw suffers deterioration from bacteria eating into the bone. The bone also doesn’t weaken in a specific location, rather softer deposits of material get eaten away, leaving a brittle patchwork that collapses.
The bones of the jaw face pressures from multiple sources. Everything from how you sleep to how you eat impacts the condition of the bones supporting your teeth.
Diabetes increases the risk of periodontal disease while also speeding up the rate of decay. A poor diet inhibits the normal healing process of the jawbone.
Grinding teeth or eating hard food such as ice or tree nuts create microabrasions. These abrasions allow bacteria and food particles to infiltrate the bone and begin eating away.
Each of these factors builds on the next. As you lose teeth from decay, the resulting holes allow more access. The loss of infrastructure leads to more damage from chewing and grinding.
The natural healing assets of the body can’t keep up and more loss occurs, spiralling the process even further.
Bone grafting combats the worst of these deteriorations by placing bone material into holes and fractures. Once placed, the original bone and the graft grow and integrate into each other until they become a single strong whole.
During a routine procedure such as tooth extraction, a dentist monitors bone density in the resulting socket. They want to stay ahead of issues and ensure that your bite stays even so that the loss of one tooth does not unbalance pressure on your other teeth.
Preventative maintenance is always imperative with an NHS dentist in London. No matter how good our technology gets, the natural materials in your mouth last longer and work better. The longer you hold on to original teeth, the slower the overall decay.
The process of grafting bones in the facial region goes back to 1682. The first grafts used animal bone. Subsequent grafts developed from human bones, usually in the thigh where it was easy to get at and could be replaced quickly.
These days, synthetic materials can be added as a growth matrix for a graft.
Surgeons separate bone grafts into four subtypes: xenografts, autografts, allografts, and synthetic materials.
Xenografts come from animal tissue or tissue foreign to the human body. Xenografts aren’t limited to bone, collagens used in joint surgery and beauty products also exist.
Autografts come from the person that gets the graft. By using tissue from one site and moving it to another, a perfect match of material is assured. Isografts, a subset of autografts come next. These grafts come from identical twins.
For those not lucky enough to have a twin, allographs come from unmatched genetic stock.
Synthetic materials can contain polymers and osteoinductive proteins. Synthetic materials benefit from the ability to be tweaked in composition to match the graft site.
Artificial vs Natural
A metastudy, the strongest of all scientific research, indicated no substantive difference between natural grafts and artificial.
As long as surgeons implant the graft properly and you heal for an appropriate time, the new bone works the same as the old.
Duration of healing also did not change from one type of graft to another.
Whenever material is transplanted into the body, it carries a risk of a phenomenon known as graft versus host. Whenever you hear about an organ being rejected, this is what’s happening. The body creates antibodies which attack the newly introduce material as if it were an invader, which it technically is.
With a graft, the risk of graft vs host is low. With auto and isografts, the risk is almost nonexistent. Synthetics come next. The highest risk comes from allographs.
Once the graft is placed, the body begins joining the old material to the new through a series of chemical chains. These include calcium, hydroxyapatite, and phosphorous. Collagens, the same cellular matrix that keeps your skin springy, can also be introduced to hold these chains together while they bond.
The insertion of additional mesh membranes keeps your gums from growing into the bone cavity. Both your bone and your gums grow to fill in gaps after extraction. The processes of guided tissue regeneration (GTR) keeps the right material growing in the right place.
No matter the graft type, eventually your body absorbs the introduced material. Like most of the rest of you, everything gets replaced and rebuilt given enough time.
Not all of the places in the mouth are equally accessible. Depending on how much bone needs to be replaced, the dentist may access the site external to the mouth.
For tooth extraction, or to graft in a particular tooth site, a graft is dropped into the excavated area. If you have a history of loss or are considered in a risk group, such as diabetes or an osteo-degenerative condition, they will add grafts with each extraction.
For grafts needed in the back portion of the upper jaw, it gets difficult to do work. For these sites, it’s best to go in through the sinuses to reach the location.
Outside of general health, anchoring implants is the main reason to get a bone graft. A dental implant starts by attaching a titanium post into the bone.
This post holds an abutment that screws in to fit securely. The dentist attaches a crown to the abutment to complete the implant procedure.
Without proper density in the bone, the implant won’t hold. It will wiggle out and cause damage to the bone, your gums, and your other teeth.
Before implant surgery, your dentist measures gum loss and bone loss. If either of these areas suffers, the implant won’t hold. Not only that, but degeneration in both areas also represents a spreading problem.
Given how much dental implants cost in the UK, it’s important to make sure they last.
To prevent further loss its important to shore up the number and placement of teeth. Even if ongoing gum loss is an issue, anchor points provide a working space to rebuild more serious causes of degeneration.
Your dentist will recommend consistent maintenance and possibly the addition of barrier membranes.
In extreme cases, all-on-4 or all-on-6 procedures may be recommended. These larger-scale implant processes connect a partial or full denture to shore up damage in the mouth.
As with any procedure, your dentist tries to save as much of the original material as possible.
Healing times vary from person to person but also based on the amount of grafting done. Typically, you recover in three to six months. If multiple sites get grafted at the same time, this can extend the healing by a few weeks.
Your overall health plays a part in your recovery time. As does your access to proper nutrients. Your dentist may provide dietary suggestions to ensure you get the right materials to aid your bone growth.
You should experience only mild pain and discomfort after a graft. Most of the pain comes from inflammation. Swelling reduces quickly and you will feel close to nothing as the bone regenerates.
Despite the intensity invoked by the idea of bone grafting, the procedure isn’t difficult. Grafting adds time to an implant process but provides a meaningful benefit.
To learn more about the procedure or to get checked if you need grafts, contact us.