Dental Bone Grafts

A bone graft is a procedure that builds up an area of the jaw by placing bone material in a defect. Over months the patient's natural bone grows in the area and replaces the grafted bone.The result is an area of the jaw that will provide a solid base for the stability of an implant or denture or simply to provide a better cosmetic appearance. The graft is either placed at the same time as an implant if an implant is needed, or the jaw is repaired in stages. For cases of large defects, it may be necessary for the bone grafting to occur in several stages with or without implants. For very large defects such as those from a cleft palate, trauma, or a destructive tumor, it may be necessary for Dr. Sabbagh to perform your surgery in the hospital. In these cases a piece of your hip may be needed to reconstruct the defect. Dr. Sabbagh with her advanced training in surgery in medical school and general surgery internship at the University of Pennsylvania is proficient in harvesting a portion of your hip if necessary. This is performed as an out patient at either St. Francis Hospital or St Joseph's Regional Medical Center.

Why a bone graft?

In certain areas of the jawbone where there has not been teeth for a long time (edentulous area) the bone shrinks or resorbs. It is the chewing forces on the teeth that transmit forces into the bone that supports the teeth. This force stimulates dense healthy bone. Just as weight bearing exercises strengthen the human skeleton, chewing transmits forces on the bone surrounding the teeth. Once the teeth are extracted, the bone begins to atrophy. Even with a bridge or a removable denture or plate, the bone is not receiving the force of chewing. The force instead is being distributed in a lateral direction along the denture or the teeth that the fixed bridge is attached (abutments). This leaves the bone in the case of the bridge where there is no tooth subject to resorption. The atrophic bone will have difficulty retaining a denture.

The Lower Jaw and Bone Loss

The lower jaw especially can have severe clinical problems associated with resorption. Since chewing, speaking and swallowing can dislodge a denture as the tongue moves, bone loss on the lower jaw can be a big problem. Often the bone is so resorbed it is necessary for Dr. Sabbagh to recommend a bone graft to help support the denture or implants. If the denture is continuously worn on a severely resorbed lower jaw, the nerve can become irritated by the ill fitting denture and patients can develop a neuroma on the ridge of the lower jaw. If you live in the Federal Way, Auburn,WA, Enumclaw or Burein area, and have pain from ill fitting dentures, call Dr. Sabbagh for an evaluation. If you have dental insurance, there is a good chance Dr. Sabbagh is a provider. Just let our knowledgeable patient coordinator know and she will connect you with the financial coordinator and your insurance will be verified. Examinations are commonly covered benefit.

Where do bone grafts come from?

There are many types of grafts. The bone graft can either be an autogenous graft (from a cadaver) or from another area of the same patient (autologous). A xenograft is a graft obtained from another species.

Autogenous Bone Graft

The cadaver or autogenous bone graft is supplied from a bone bank with strict protocol to ensure a sterile and safe product. The bone bank has similar criteria for safety as a blood bank. The donors are carefully screened and the bone is put through a stringent process to purify it for use as a graft. The grafted bone is placed in a defect where bone has been lost to resorption,infection or trauma. The graft area must be left alone and chewing must be kept to soft foods to allow the proper healing to occur. After you receive a bone graft, Dr. Sabbagh will review with you how to care for the area. You will be given her phone number in the event you have any questions or concerns after hours.

Autologous Bone Graft

The autologous bone graft is obtained from another area of your own body. The area chosen to harvest a graft is called the donor site. The area receiving the graft is called the recipient site. If a bone defect in one part of your mouth needs a graft, a patient may choose to have a nearby region of the mouth as the donor site. In some cases are advantages to an autologous graft as opposed to an autogenous graft. Dr. Sabbagh will discuss the pros and cons of each graft choice and help you understand what best meeds your needs for the optimum result.

Xenograft

The bone graft can also be from another species such as a cow or bovine sources. This type of graft is called a xenograft. A xenograft is obtained from another species besides a human. We are familiar with the pig valve for cardiovascular surgery. This is a xenograft. In oral and maxillofacial surgery the bovine graft is occasionally used. This is also a xenograft.

Synthetic Grafts

Occasionally a synthetic graft is used in certain areas of the mouth. The difference between the synthetic graft and the autologous or autogenous graft is that the synthetic graft is not broken down and replaced by the patient's natural bone. The synthetic graft is often used to increase thickness in the gum area where a fuller aesthetic result is needed.

What is a membrane?

Often a membrane is placed over the newly grafted areas to prevent the overlying tissue from growing into the area. The membrane can be autogenous, autologous, or synthetic. Depending on the situation, Dr. Sabbagh can recommend the best graft for your reconstructive situation. Dr. Sabbagh's vast fund of knowledge on advanced bone grafting techniques allows her to customize the graft that is right for your situation.