Bone Grafting & Socket Preservation

Bone Grafting & Socket Preservation Movie

In the United States alone, thousands of teeth are extracted annually, primarily because of decay, severe periodental disease, infection, or trauma. The jaw bone that supports the teeth, “alveolar” bone, which is generally soft and vascular, often melts away or resorbs following tooth removal. Such bone resorption can result in significant cosmetic or functional defects, including loss of surrounding gum tissue.

Bone and soft tissue

Today, however, bioengineering has led to simple but effective surgical techniques that can either totally prevent or greatly reduce the bone and soft tissue loss that normally occurs following tooth extraction. This brochure will introduce you to a simple yet effective procedure that will help prevent such tissue loss from occuring following tooth extraction.Without technique

Fig. #1A- Gum tissue has receded resulting in abnormal appearance of front teeth.
Fig. #1B- Gum tissue has receded resulting in gaps between teeth.

Preservation technique

Fig. #2A- Gum tissue is preserved resulting in normal appearance.
Fig. #2B- Procedure maintains normal gum contour.
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What generally occurs to the surrounding bone and tissue following tooth extraction?

Tooth extraction is one of the most common dental procedures. Healing of the resulting extraction socket normally occurs unevenfully. However, even with completely normal healing, there is often some resorption or melting away of the surrouding bone, resulting in less height and width that were present prior to tooth extraction. In addition, as bone resorbs the overlying gum tissue also tends to lose both volume and its normal anotomic form. These changes can occur anywhere but the most severe loss of bone and gum tissue tends to occur following removal of incisor teeth located in the front of the mouth.
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Why is preserving bone and surrounding gum tissue important?

Loss of bone and gum tissue following tooth extraction often results in both functional and cosmetic defects. Such tissue loss often results in an unsightly collapsed appearance, especially in the front of the mouth where proper maintenance of tissue health is critical to normal esthetics. In addition, loss of bone and gum tissue often compromise the dentist’s ability to adequately replace the missing tooth or teeth with either conventional removable or fixed bridgework or with a dental implant supported restoration.Sometimes the loss of bone is so severe that additional surgical procedures are required prior to replacing the missing tooth with either a conventional or implant supported restoration.
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How can bone and gum tissue be preserved following tooth extraction?

Today, because of advances in dental surgical procedures and bioengineering, bone and gum tissue loss following tooth removal can either be greatly reduced or completely eliminated. Following removal of the tooth a specially bioengineered graft material that helps support bone formation is placed within the extraction socket. This bone graft material, Bio-Oss®, with structure similar to human bone, not only supports new bone growth but also has been shown to preserve bone and overlying soft tissue following tooth removal.The Bio-Oss® graft material is then convered with a natural fiber material, collagen, to protect both the graft and newly forming bone as well as to help support and help guide new soft tissue growth. Together, the Bio-Oss®/Collagen system helps prevent bone and gum loss following tooth removal.
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What are the step-by-step procedures required to preserve bone and gum tissue following tooth extraction?

Step #1- Diagnosis of a tooth requiring extraction
Step #2- Extraction of the tooth using a gentle surgical technique.
Step #3- Placement of the Bio-Oss® bone graft material into the extraction socket.
Step #4- Placement of the resorbable collagen dressing in densely packed layers over the Bio-Oss® bone graft and suturing.
Step #5- Temporary restoration to replace missing tooth and specially shaped to help support healing of the gum tissue.
Step #6- Final prosthetic result with fixed bridgework and preserved surrounding bone and gum tissue.
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What is Bio-Oss® porous bone mineral?

Bio-Oss® is a safe, effective bone graft material from specially processed bovine sources. Under the electron microcope, Bio-Oss® looks very similar to human bone. Because of its similarity to human bone, Bio-Oss® is highly successful in helping new bone to form. In many cases, using Bio-Oss® eliminates the need for additional surgery to obtain your own bone as grafting material.
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How does Bio-Oss® work?

Since Bio-Oss® is so similar to human bone, it is readily accepted by our defense mechanisms as a “friendly” graft and is therefore not rejected. Bio-Oss® acts as a framework into which bone forming cells, blood vessels, etc. migrate. As these cells and blood vessels travel along the Bio-Oss® framework, healthy new bone is formed and the defect is repaired.
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Is Bio-Oss® safe?

Bio-Oss® is completely safe. Since it is highly purified bone, no allergic reactions or infections have been observed following its use. Every batch of Bio-Oss® goes through highly controlled processing and sterilization procedures which remove all impurities. At the end of these procedures, every batch of Bio-oss® must pass rigorous tests for purity and sterility, assuring the total safety of the materials.
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How long does it take for new bone graft to form around the Bio-Oss® graft?

Bio-Oss®, because of its similarity to human bone, is highly successful in in supporting new bone growth. Although new bone will begin to form within the first few weeks after grafting, several months are required to achieve the quantity and density of bone needed for further dental or surgical procedures to be performed. (Time may vary. Ask your dentist about your specific case).
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What is Bio-Gide®, bilayer collagen membrane?

Bio-Gide® is a thin resorbable GBR membrane made from the natural fiber material, collagen. Often when a bone graft is needed, Bio-Gide® is placed directly over the grafted material. Bio-Gide® encourages new bone to form and also prevents the growth of scar tissue into the grafted site.
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How is Bio-Gide® different from other membranes?

Bio-Gide® is resorbable (melts away) and therefore, unlike membranes which do not resorb, does not need a second surgical procedure to be removed. Unlike most other resorbable membranes which tend to resorb in 4-8 weeks, Bio-Gide® lasts at least 4 months, the time required for new bone to form. And lastly, during healing, if an opening occurs in the gum tissue covering Bio-Gide®, the opening will tend to close spontaneously, allowing bone growth to continue. Removal of the Bio-Gide® membrane is almost never required.
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Is Bio-Gide® safe?

Bio-Gide®, like many artificial heart valves, is composed of porcine derived collagen. Using special processing and sterilization procedures, Bio-Gide® is made completely biocompatible and sterile. Every batch of Bio-Gide® membranes undergoes a series of tests confirming its purity and sterility, assuring total safety of the materials. Bio-Gide® is not indicated for patients with a known history of allergic response to collagen or procine derived products.
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Can dental implants be used in conjunction with this bone and gum tissue preservation technique?

View A- Implant in the extraction socket with surrouding Bio-Oss® and temporary crown in place.

Today, instead of replacing missing teeth with conventional fixed or removable prostheses, (eg. “bridge or partial denture”) dental implant supported restorations are often considered excellent alternatives. Depending on the condition of the remaining extraction socket following tooth removal or may be placed three or four months later. In either case, preserving the surrounding bone and soft tissue with placement of a Bio-Oss® graft and resorbable collagen dressing can be performed in a manner similar to the procedure used with conventional fixed or removabale tooth replacements. When a dental implant is placed into the extraction socket immediately following tooth removal, the Bio-Oss® graft material is carefully packed between the metal implant and the inner socket walls. In the position, the Bio-Oss® graft helps support bone growth needed to stabilize the dental implant, while at the same time helping to preserve the surrounding bone and gum tissue (View A).

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Are tooth extractions and bone preservation procedures painful?

These procedures are usually done in the doctor’s office under local anesthesia or local anesthesia with I.V. sedation or occasionally general anesthesia. The procedures themselves are without pain. Post-operatively, there may be some swelling and mild to moderate discomfort. Your doctor will prescribe an oral analgesic to help relieve your discomfort.
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What special care is required after grafting the tooth socket?

Generally, the same prudent care required after any dental surgical procedure will be sufficient following tooth extraction and bone preservation procedures. The area must be kept clean, often with the help of a prescribed mouth rinse. An antibiotic, if prescribed by your doctor, must be taken. Antibiotics, however, are not always required. Undue pressure over the graft extraction site must be avoided until new bone is well on its way to being formed. And finally, brush and floss your teeth as you normally do. However, avoid the gum tisuues surrounding the grafted extraction socket until they are well healed (usually about six weeks).

Bone Graft From Donor Site

If the Ridge is insufficient you may require a bone graft from a donor site in order to make the ridge wider to be able to get dental implants

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