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Augmentation Procedures

When a tooth is extracted, the healing of the tooth socket involves the jaw bone remodelling as a normal process. This results in bone loss which can sometimes compromise the placement of dental implants. Success in dental implant treatment is much more likely when there is an adequate amount of bone and also the bone is in the right anatomical position. If there is a lack of bone then an implant is not possible. A variety of procedures are available to increase the amount of bone prior to dental implant placement. These procedures can be performed both under a local anaesthetic or a general anaesthetic:-

A    Socket preservation and contouring

Bio-oss granuals in a tooth socket.This procedure involves the placement of artificial bone - Bio-oss - into the tooth socket (picture right) at the time of the tooth extraction.

Bio-oss is a specially prepared artificial bone in the form of granules which convert to normal bone over a period of 3-4 months.The membrane placed over the Bio-oss material after filling the socket.

It is known that the placement of this material will preserve the tooth socket in readiness for a dental implant.

In most cases the granules have to be retained in the socket (see picture left) by using a membrane over the socket.

B.    Sinus lift procedures

Maxillary sinus lift diag AThe maxillary sinus is an air-filled cavity just below the cheekbones which is connected to the nose (diagram right).

When posterior maxillary teeth (upper back teeth) are extracted, the bone, like any other part of the jaw bone, remodels in the normal process of healing.

This can sometimes result in a lack of bone in the posterior maxilla for dental implant placement.

To increase the amount of bone in the posterior maxilla (upper back jaw), a procedure known as a sinus lift procedure is performed. 

Maxillary sinus lift diag B.This can be done on one (unilateral) or both sides (bilateral) of the jaw. Bilateral sinus lifts are performed at the same time.

The procedure can be carried out under a local, or more often, a general anaesthetic.

However, even under general anaesthetic, surgery does not require an overnight stay in hospital.

Maxillary sinus lift diag C.The procedure lifts up a flap of gum and the sinus is entered.  Granules of Bio-oss are packed into the floor of the sinus (diagram above) to increase the height of the bone in the posterior maxilla.

The Bio-oss granules are covered with artificial membrane (diagram right) and the gum stitched over with dissolvable stitches. Four months later, dental implants can be inserted into the posterior jaw onto which crowns and bridges can be fitted at a later date.

C.    Onlay graft

In the upper front jaw (anterior maxilla) bone remodelling frequently involves the loss of the outer or lip surface of the jaw bone. This makes the placement of dental implants, particularly in the correct position, very difficult.

Onlay grafting involves the placement of bone on the outer surface of the anterior upper jaw bone. In this procedure, the patient’s own bone is preferred to provide the best contour and lip support. For small defects (a single missing tooth), bone from the lower jaw is taken and placed into the top front jaw. Where several teeth are missing, a larger piece of bone is required, usually taken from the iliac crest (hip bone).

In some circumstances, the bone requires a screw to hold it in place during the healing process. Three to four (3-4) months later dental implants can be placed into the bone graft (if required the screws are removed at the time of implant placement).