Replacing Bone for Dental Implants
In its early stages, gum disease is known as gingivitis. Gingivitis is characterized by swelling in the gingiva, or gum tissue, and is reversible. The primary characteristic of gingivitis is swelling and possibly bleeding of the gums, and gingivitis is most commonly caused by an excessive amount of bacterial plaque that has accumulated on the surfaces of the teeth. Gingivitis is treated by removing this excess plaque and tartar, which is done with daily oral hygiene along with regular professional dental cleanings. When treated, gingivitis is completely reversible. If it is not treated, however, gingivitis can develop into periodontitis. Periodontitis is the inflammation of the periodontium, which is the set of specialized tissues that surround and support the teeth. The periodontium is made up of four separate types of tissue: the gum tissue; the periodontal ligament, which is the collection of fibers that attach the gums to the tooth; the cementum, which is the mineral coating that protects the root of each tooth and attaches to the periodontal ligament; and the alveolar bone, which is the specialized bone that crowns the jaw bone and serves as a socket for the teeth. If this complex structure becomes inflamed in response to a bacterial invasion, the tissues of the entire periodontium are slowly destroyed. This means that the ligament detaches from the cementum, allowing the teeth to loosen and eventually fall out.
What some people may not know, however, is that periodontitis also causes the bone to degrade. As the bacteria in the mouth proliferate and metabolize, infection invades the bone and begins to break it down; as it breaks down, bone tissue is resorbed by the body. Of course, teeth require a firm foundation if they are to withstand the forces placed on them by chewing, biting, and in general, so if a person has decided to undergo a dental restoration and replace their missing teeth, the bone must first be rebuilt. There are a few different approaches to replacing bone for dental implants, though the foundation for regenerating bone is a procedure called a bone graft.
The bone graft procedure is performed by a periodontist, a dentist who specializes in diagnosing, treating, and preventing diseases of the periodontium. The periodontist first makes an incision in the gum tissue and folds the tissue back, exposing the area beneath the gum and thoroughly cleaning that area, freeing it of infected tissue and dental calculus while also smoothing rough surfaces to help them resist further plaque accumulation. Once the area is thoroughly clean, the dentist will place the bone graft into the cleaned area. The bone graft is placed inside the existing bone tissue and helps stimulate the patient’s body to make new bone. If the natural teeth are still present, a bone graft can increase the chances of keeping the teeth. If the teeth do fall out, however, they can be replaced, either with a removable denture or with longer-term dental implants. Dental implants are vastly preferable to removable dentures, providing the most natural replacement teeth in both appearance and function. Dental implants also confer an additional benefit: when the implant is placed into existing bone, the bone is stimulated much like it is when a bone graft is placed. Once the implant heals, the bone has fused with the implant, and the implant becomes a replacement root for a strong, stable tooth.
Of course, it’s impossible to place an implant if there is an insufficient area of bone in which to do so. This is where bone grafts become necessary. Sometimes, only a minimal amount of material needs to be grafted, in which case the procedure can be done along with implant surgery, at the same time. If larger amounts of bone need to be grafted, the bone must fully heal and demonstrate successful growth, over the course of several months, before the implant can be placed.
Several different types of materials can be used for bone grafts. An autograft uses bone from the patient’s own hip bone or from another area of their jaw; other areas may be used in specific circumstances. An allograft is a graft that uses bone from a human donor, and a xenograft is a graft that uses animal bone. An alloplast uses a grafting material that is synthetic, made of a compound that contains phosphorus, calcium, and hydroxylapatite. You and your doctor can discuss the right graft material for you. Your doctor may also use guided tissue regeneration as part of your bone graft procedure. This procedure uses a tiny piece of mesh, placed between the gum tissue and the grafted bone, as a sort of dam that prevents gum tissue from growing into the cavity where the bone is intended to grow. Guided tissue regeneration may be used in conjunction with growth factor proteins that stimulate the bone tissue and encourage its growth, and innovations in these technologies are constantly occurring as dental implant technology continues to rapidly develop.
Of course, the best way to avoid having to undergo any bone graft procedure is to prevent periodontitis from developing in the first place. A strong oral hygiene routine is one of the most effective ways to stave off gum disease. Dentists recommend brushing the teeth twice a day, using a soft-bristled brush to gently brush fluoride toothpaste into the surfaces of the teeth and under the gumline, as well as cleaning between the teeth daily, a process that usually involves dental floss but may utilize a different specially designed interdental cleaning tool. When bacterial plaque isn’t removed from the teeth, it hardens and turns into dental calculus, commonly known as tartar. Tartar can’t be removed with home cleaning and requires the use of the specialized clinical tools that dental hygienists use in a routine dental cleaning. Because it is impossible to remove every tiny bit of plaque from the teeth, even regular brushing should be paired with periodic professional cleanings, as well as dental checkups to ensure no larger concerns are present. If you do develop periodontitis, good oral hygiene along with working closely with your dentist can help you maintain your natural teeth for as long as possible.