Bone Grafting and Sinus Lifts

What are they?

For dental implants to be successful, the jawbone must have enough bone to support them. Tooth loss often leads to more loss of bone. The tooth loss may be caused by periodontal (gum) disease, dental caries (cavities) and infection, injury or trauma, or a developmental defect. If the bone under your gum is not tall enough, not wide enough or both, you will need a procedure to add bone to your jaw before implants can be placed. We typically graft the socket following an extraction to prevent bone loss that typically occurs:

Bone augmentation is a term that describes a variety of procedures used to "build" bone so that dental implants can be placed. These procedures typically involve grafting (adding) bone or bone-like materials to the jaw. The graft can be your own bone, bovin bone, synthetic bone or bone obtained from a cadaver. After grafting, you have to wait several months for the grafted material to fuse with the existing bone. A graft from your own bone transplants bone cells or a block of bone that fuses to the jaw. The graft can be held to your jaw with small screws (as seen in picture below). The screws are usually not seen during the healing period and they are removed at the time of implant placement.

Several different procedures can be used for bone augmentation. Dr. Kahenasa will go over your options and we will select one depending on the type, location and number of implants to be used. If you need a bone graft, it is important that you discuss with your dentist and Dr. Kahenasa all of the options available to you.

After bone augmentation, we usually wait three to nine months before placing implants.

A sinus lift is surgery that adds bone to your upper jaw in the area of your molars and premolars. It's sometimes called a sinus augmentation. The bone is added between your jaw and the maxillary sinuses, which are on either side of your nose. To make room for the bone, the sinus membrane has to be moved upward, or "lifted." A sinus lift is done when there is not enough bone in the upper jaw, or the sinuses are too close to the jaw for dental implants to be placed. This could be due to:

• Tooth loss may have led to a loss of bone as well. Once teeth are gone, bone begins to be resorbed (absorbed back into the body). If teeth have been missing for a long time, there often is not enough bone left to place implants.
• The maxillary sinus may be too close to the upper jaw for implants to be placed. The shape and the size of this sinus varies from person to person. The sinus also can get larger as you age.

Preparation and Surgery

The bone used in a sinus lift may come from your own body (autogenous bone), from a cadaver (allogeneic bone) or bone morphogenic protein (BMP).

If your own bone will be used in the sinus lift, it will be taken from other areas of your mouth or body. In some cases, we would need to remove bone from your hip or tibia (the bone beneath the knee).

You may need X-rays or a CT scan taken before your sinus lift so that Dr. Kahenasa can study the anatomy of your jaw and sinus. The CT scan will allow Dr. Kahenasa to accurately measure the height and width of your existing bone and to evaluate the health of your sinus.

The procedure is typically performed with local anesthesia along with IV sedation but the ultimate treatment plan will be dependent on your medical history, current state of health and surgical needs.

Follow-Up

After the procedure, you may have some swelling of the area for 3-5 days. You may bleed from your mouth or nose. Do not blow your nose or sneeze forcefully. Either one could cause the bone-graft material to move, and loosen the stitches. Smoking is also strictly off-limits since it can directly affect your sinus cavity.

We may also give you saline sprays to keep the inner lining of your nose moist. If you have seasonal allergies, you should schedule the procedure when they are not active. You also will usually be given pain medicine, antibiotics and an antimicrobial mouthwash to help prevent infection. Most patients have some discomfort after a sinus-lift procedure but discomfort is manageable when taking the prescribed medicines.

After a sinus lift, you will need to wait several months for the bony material to harden and integrate with your jaw. Depending on the grafting material used, implants may be placed in four to nine months.

Risks

The main risk of a sinus lift is that the sinus membrane could be punctured or torn. If the membrane is torn during the procedure, we will usually place a patch over it. If the repair is not successful, we may stop the procedure and give the hole time to heal.

The sinus lift can be redone once the membrane has healed. This usually takes a few months. A healed membrane tends to be thicker and stronger, which means a second attempt at a sinus lift is likely to be successful.

Infection is a risk of any surgical procedure, including sinus lifts.

On rare occasions, the existing bone does not integrate with the bony graft material, and the grafted area does not develop a blood supply. If this happens, any implants placed in this area will fail because there is no live bone for them to attach to. If this happens, you can choose to have the sinus lift procedure repeated.

Success of Bone Grafting

The success rate for bone grafts in the jaws for the purpose of placing dental implants is high. However, there is always a chance that the bone graft will fail, even if your own bone was used. Bone grafts are not rejected like organ transplants and we don't always know why some bone grafts fail. We do, however, know that certain people—such as those who smoke and those with certain medical conditions—have higher risks of graft failure than others do. A failed graft will usually be removed. Once the area has healed, we may choose to place a second graft.

If you would like a consultation to discuss bone grafting or sinus lift options please contact Dr. Kahenasa using the information on the "practice locations" link.