Dental Implant Specialists in Modesto

Major Bone Grafting For Dental Implants

Causes Of Jawbone Loss

When one or more teeth are missing, it can lead to jawbone loss at the site. This loss of jawbone can develop into additional problems, including problems with remaining teeth, altered facial appearance, and difficulty eating and speaking.. In that same way that muscles are maintained through exercise, bone tissue is maintained by use. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and is lost.

When an adult tooth is removed and not replaced, jawbone deterioration may occur. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and goes away. The rate the bone deteriorates, as well as the amount of bone loss that occurs, varies greatly among individuals and tooth location in the mouth. However, most loss occurs within the first eighteen months following the extraction, and continues throughout life.
Periodontal diseases are ongoing infections of the gums and bone that gradually destroy the support of your natural teeth. While there are many diseases which affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues, and are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it precedes periodontitis. Dental plaque is the primary cause of gingivitis in genetically-susceptible individuals. Plaque is a sticky colorless film, composed primarily of food particles and various types of bacteria, which adhere to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produce toxins or poisons that irritate the gums. Gums may become inflamed, red, swollen, and bleed easily. If this irritation is prolonged, the gums separate from the teeth causing deep pockets to form. If daily brushing and flossing are neglected, plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line. Periodontitis is affected by bacteria that adhere to the tooth’s surface, along with an overly aggressive immune response to these bacteria. If gingivitis progresses into periodontitis, the supporting gum tissue and bone that holds teeth in place deteriorates. The progressive loss of this bone, the alveolar, can lead to loosening and subsequent loss of teeth.
Unanchored dentures are placed on top of the gums, and therefore do not provide any direct stimulation to the underlying alveolar bone. Over time, the lack of stimulation causes the bone to resorb and deteriorate. Because this type of denture relies on the bone to hold them in place, people often experience loosening of their dentures and problems eating and speaking. Eventually, bone loss may become so severe that dentures cannot be held in place even with strong adhesives, and a new set may be required. Proper denture care, repair, and refitting are essential to maintaining oral health. Some dentures are supported by dental implants, which do help adequately stimulate, and therefore preserve bone. With bridgework, the teeth on either side of the appliance provide sufficient stimulation to the bone, but the portion of the bridge that spans the gap where the teeth are missing receives no direct stimulation. Bone loss can occur in this area.
If the dental infection reaches the nerve space inside the tooth, the nerve can die and cause infection in the bone around the tooth.
When a tooth is knocked out or broken damage to surrounding jawbone can occur. This injury can result in jawbone loss and infection. A bone grafting procedure would be necessary to reverse the effects of bone deterioration, restoring function and promoting new bone growth in traumatized areas.
Misalignment issues can create a situation in the mouth where some teeth no longer have an opposing tooth structure. The unopposed tooth can over-erupt, causing deterioration of the underlying bone. Issues such as TMJ problems, normal wear-and-tear, and lack of treatment can also create abnormal physical forces that interfere with the teeth’s ability to grind and chew properly. Over time, bone deterioration can occur where bone is losing stimulation.
Some conditions or syndromes known as birth defects are characterized by missing portions of the teeth, facial bones, jaw or skull. Dr. Filippi may be able to perform a bone graft procedure to restore bone function and growth where it may be absent.
When molars are removed from the upper jaw, air pressure from the air cavity in the maxilla (maxillary sinus), causes resorption of the bone that formerly helped the teeth in place. As a result, the sinuses become enlarged, a condition called hyperneumatized sinus. This condition usually develops over several years, and may result in insufficient bone for the placement of dental implants. Dr. Filippi can perform a procedure called a “sinus lift” that can treat enlarged sinuses.

Jaw Bone Health

When one or more teeth are missing, it can lead to jawbone loss at the site. This loss of jawbone can develop into additional problems, such as problems with your remaining teeth, and altered facial appearance, and eventually even the inability to speak and eat normally. In that same way that muscles are maintained through exercise, bone tissue is maintained by use. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and is lost.

Potential Consequences of Tooth and Jawbone Loss

  • Problems with remaining teeth, including, misalignment, drifting, loosening and tooth loss
  • Collapsed facial profile
  • Limited lip support
  • Skin wrinkling around the mouth
  • Distortion of other facial features
  • Jaw (temporomandibular joint [TMJ]) pain, facial pain, and headaches
  • Difficulty speaking and communicating
  • Inadequate nutrition as a result of the inability to chew properly and painlessly
  • Sinus expansion

Why Do I Need A Bone Graft?

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. This often leaves a condition in which there is poor quantity and / or quality of bone suitable for placement of dental implants. In these situations, patients may not be candidates for placement of dental implants. Bone grafting is the technique to reconstruct missing 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.

The bone is either obtained from a tissue bank or another area in your mouth. In addition, special membranes may be utilized that protect the bone graft and encourage bone regeneration. This is called Guided Bone Regeneration (GBR). Socket grafting, ridge grafting and sinus grafting are types of Guided Bone Regeneration.

Do I Have Enough Bone?

After tooth extraction, if the walls of the socket are very thick, they will usually fill naturally with bone in three to four months. However, when the walls of your socket are very thin (such as in your upper and lower front teeth) or if there already is bone loss, this type of healing will not be as predictable. In these situations, a bone graft is often placed at the time of tooth extraction to help your body fill in the empty socket with bone. This step will maintain the width and volume of bone you will need for implant placement several months later.

There may be inadequate bone for implant placement if your tooth was removed many years ago and your bony ridge is extremely thin. In this case, a bone graft can be placed first and allowed to heal for up to six months. After the graft has fused to your pre-existing bone, the ridge will be re-entered and the implant placed. Bone grafting is usually a relatively comfortable office procedure. Many different bone-grafting materials are available, including your own bone.

Socket Grafting

When a tooth is removed because of pain, infection, bone loss or fracture of the tooth. The bone that holds the tooth in place (the socket) is often damaged by disease and/or infection resulting in deformity of the jaw after the tooth is extracted. In addition, when teeth are extracted, the surrounding bone and gums can very quickly collapse after the extraction resulting in unsightly defects and collapse of the lips, and cheeks.

These jaw defects can create major problems in performing restorative dentistry whether your treatment involves dental implants, bridges or dentures. Jaw deformities from tooth removal can be prevented and repaired by a procedure called socket grafting. Socket grafting can greatly improve your smile’s appearance and increase your chances for successful dental implants for years to come. Several techniques can be used to preserve the bone and minimize bone loss after an extraction. In one common method, the tooth is removed and the socket is filled with bone or bone substitute. It is then covered with gum, artificial membrane, or tissue stimulating proteins to encourage your body’s natural ability to repair the socket. With this method, the socket heals eliminating shrinkage and collapse of surrounding gum and facial tissues. The newly formed bone in the socket also provides a foundation for an implant to replace the tooth. If your dentist has recommended tooth removal, be sure to ask if socket grafting is necessary. This is extremely important if you are planning on replacing the front teeth.

Ridge Grafting

A ridge graft is performed in a site where the tooth is already missing. Dental implants need to be completely surrounded by bone to support the chewing forces placed upon the implant. A ridge graft reconstructs the width and sometimes the height around a dental implant. Typically a ridge graft is done at same appointment as dental implant placement. Sometimes the ridge graft needs to be done as a separate procedure prior to dental implant placement.

Sinus Lift

The Maxillary Sinuses are located in your cheeks above your top, back teeth. Your sinuses are air filled spaces connected to your nasal passages. As people get older, the sinus spaces increase in size. In many adults the sinus are right atop the roots of the upper molar teeth. When the upper molars are moved, there is often only a thin wall of bone separating the bottom of the sinus from the tooth sockets. This is inadequate bone to secure a dental implant. In order to replace the upper molars the first step is to preserve as much of the jaw bone as possible immediately upon tooth removal with a socket graft (see above). For many adults a sinus graft is also necessary to reconstruct additional bone. A sinus graft pushes up the bottom of the sinus space and reconstructs bone where bone used to be at some time in the past.

One type of sinus graft is done at the time of dental implant placement through the same hole in the jawbone into which the dental implant is placed. In areas where there is minimal residual jaw bone, a different type of sinus graft is necessary prior to implant placement. This second type of sinus graft is shown below.

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If you are ready to have a bright and healthy smile, feel free stop by our office Monday through Thursday. You can also request an appointment or simply give us a call.


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