Why Reconstruct?
The success of a dental implant depends, a lot on the process of natural growth of bone surrounding the implant. For this, and to provide an initial holding strength, a minimum bone mass must be present on the site of the proposed implant. Tissue reconstruction before the placement of a dental implant may be done before or even during the implant process, depending on the decision of the surgeon.
Hard tissue Reconstruction-Grafting
Bone mass requirement for an implant depends on the size and position of the implant. It also depends on the nature of the prosthesis the implant has to support-whether single tooth or multiple. It also depends on whether the implant is connected to other implants for sharing the load. A rule of thumb goal, however, a minimum bone height of 10mm, and minimum width of 6mm is required
Bone deficiency classification: For standardization, bone deficiencies may be classified by letter grades A-D as:
10mm or more A
7mm to 9mm B
4mm to 6mm C
0 mm to 3mm D
If bone depth or width is insufficient for the planned implant bone grafting can be done. Two types of sources exist for the graft material.
Grafting Techniques
Many techniques have evolved over the years to ensure sufficient height and width of bone for the implant in mind. Guided bone graft augmentation is the most popular. Two sources are possible for the graft material. The safest is autograft or harvested bone tissue, where bone is ‘harvested’ from the body of the patient himself. Suitable sites for harvesting are the back of the lower jaw, or the pelvic region (iliac crest).
Allograft (allo, meaning other) means the additional bone required is taken from another donor. Alternatively, artificial (cadaveric) bone pieces are used as a scaffold for natural bone growth..
Common Procedures for Bone Augmentation
Three types of procedures are common:
Sinus Lift
Alveolar Augmentation-Lateral (width increase of bone)
Alveolar Augmentation-Vertical (height increase of bone)
Other Procedures
Other procedures, rather more invasive, are available for bone defects which are larger. These include:
Shifting the inferior alveolar nerve to create space for fixture placement
Onlay, where bone from the iliac crest, or if possible, another larger source may be used.
Microvascular graft: Blood supply to the graft material is also transplanted with it and connected to the local bone supply.
Reconstruction of Soft Tissue or gingiva
The implant needs strong a band of gingiva attached to it for good long term health. Also, for esthetic reasons, a band of plump gingiva is necessary to fill up the interdental region on either side. If sufficient thickness of gingiva is not present it can be augmented with a graft of soft tissue. Four methods are available for soft tissue graft:
- Adjacent tissue can be shifted towards the implant
- Gingiva can be transplanted from the palate
- Deeper connective tissue can be transferred, again from the palate
The selection of a particular method will depend on the implant parameters and the local conditions.
Let’s Have a Chat
If you’ve been considering implants but have concerns about reconstruction tissue, please don’t hesitate to ask Josey Lane Dentistry questions. We’re happy to help you make sure you understand everything involved, and can make an implant plan to restore your smile.
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