Restoration and expansion of bone tissue. Splitting of the alveolar process: animation and video of the operation

About half of all cases of dental implantation require preliminary osteoplasty surgery - building up the missing bone for subsequent implantation. The reason is that the time period between tooth extraction and the moment when the patient finally decides to proceed with implantation is too long: many people come to the dentist after a year or more, while the optimal period is 2-3 months.

Bone tissue augmentation during dental implantation: indications, contraindications, preparation for surgery

Dentists' advice not to delay after tooth extraction has a purely practical meaning - every month the bone, deprived of natural load, becomes thinner and loses its natural volume. In dentistry, this process is called bone tissue degeneration and at a certain stage it becomes the main obstacle to implantation, and therefore a direct indication for osteoplasty.

Bone tissue atrophy is a direct indication for bone grafting surgery.

But, like any operation, bone grafting during implantation has many contraindications. These include:

rhinitis of any etiology: viral, allergic, vasomotor, in the acute or chronic stage;
sinusitis;
sinusitis;
pathological deviations in the anatomical structure of the respiratory organs;
the presence of polyps in the nose;
loose bone;
lack of calcium in the body;
oncological diseases;
diabetes mellitus and other ailments that negatively affect the healing process of soft tissues;
periods of pregnancy and lactation.

Obviously, with an impressive list of contraindications, it is necessary to remember the importance of such an important stage as preoperative preparation. It necessarily includes a thorough examination by a doctor, blood tests (detailed and for sugar), as well as x-rays of the sinuses.

To prevent possible complications, the surgeon prescribes oral antibiotics and hormonal drugs - they are designed to facilitate the rehabilitation period and neutralize the manifestation of side effects such as swelling and inflammation.

Bone grafting for dental implantation: advantages and disadvantages of the procedure

Often, the need for additional surgery to restore bone becomes the reason why patients finally abandon the already very complex and fraught with complications implantation procedure. But is it really as scary as you might imagine? Most experts agree that if all precautions are taken and the correct sequence is followed, the risk of complications with osteoplasty is no greater than with any other operation. At the same time, upon completion of the procedure, the patient will receive the following advantages:

Bone grafting allows you to restore the functionality of the gums.

restoration of gum functionality even with large loss of bone volume;
the possibility of implantation, which in modern dentistry is significantly ahead of other methods of prosthetics;
attractive appearance of the gums;
relatively easy recovery and no discomfort when chewing.

The inconveniences that the patient will have to endure, in turn, include long-term rehabilitation, which, depending on the combination of various factors, can take at least 1 month, and, in addition, a number of restrictions. Thus, those who have undergone bone tissue augmentation should monitor their health very carefully - ARVI and other viral diseases are undesirable during this period. They delay rehabilitation and can cause infection of the operated tissues.

Expert opinion. Dentist Abramov P.Yu.: “In addition, the artificial bone should not be subject to excessive pressure, since an excessive load can dislodge the implant and jeopardize the result of a long and difficult joint work between the surgeon and the patient. A similar risk occurs even during a sharp sneeze or a strong, hacking cough, which is an additional reason to protect yourself from colds. To improve health, the doctor may prescribe the patient to regularly take special immunomodulating drugs. For the same reason, the patient is recommended to refrain from air travel and diving for some time, engage in active sports, and drink through a straw.”

Methods of bone grafting

There are several types of bone restoration operations:

bone block grafting,
guided tissue regeneration (NTR),
basal implantation (sinus lift).

Let's look at each of them in more detail.

Bone block grafting technique is a manipulation during which the patient himself acts as a bone donor. The required graft is taken from his lower jaw (sometimes from his chin) and screwed with special screws for osteosynthesis. After this, the operated segment is compacted with bone chips or granules replacing them, which accelerate the healing of the block. The entire structure is covered with a special membrane on top, then the gums are sutured. The membrane is a material necessary for bone grafting - it protects bone chips and granules from being washed out and isolates them from soft tissues. It comes in two types - resorbable (self-absorbing) and non-resorbable. The use of the first type has more advantages, but is not always possible. If the surgeon has chosen a non-resorbable material, it will subsequently have to be removed surgically.

When transplanting a bone block, the patient acts as a donor for himself.

Disadvantage This technique causes additional trauma to the patient: there are two wounds in his oral cavity at once - at the site of bone collection and at the site of its implantation. In addition, this method does not provide for the immediate placement of dental implants, which means that after rehabilitation the patient will need to undergo another surgical intervention.

Advantage method - minimizing the risk of material rejection, since it belongs to the patient and is not perceived by his body as foreign.

NTR method differs from the previous one in that bone material of foreign origin, most often obtained from cattle, can be used during it. The probability of rejection of such a bone is only a few percent higher than with an autogenous transplant, and in general this method in most cases gives very good results. The use of a membrane in NTR is also mandatory.

Sinus lift It differs from the two previous methods in that it allows immediate loading, or, in other words, immediate tooth implantation. The operation can be used immediately after tooth extraction, and several months after it. In the first case, there is no need for augmentation, but in the second, the required number of implants are first introduced into the patient’s bone, which are sealed on top with shaving bone material, after which they are covered with a membrane and sutured with gum tissue. During sinus lifting, implants of a special type are used - they are thinner and longer, as a result of which they are able to securely anchor in the gums even with slight atrophy.

Today there are two types of sinus lift - openAndclosed. Their use depends on which layer needs to be built up - if its thickness is only 1-2 mm, then they resort to a simpler, closed method, if more, then there is a need to use an open sinus lift.

Sinus lifting comes in open and closed types.

If the overall picture allows, then immediately after this the doctor will install, which are most often made of plastic or metal-plastic. Otherwise, the patient will have a gum former implanted - a special design designed to prepare soft tissues for implantation. The undoubted advantage of sinus lifting is that it is one-stage, and therefore minimally traumatic for the patient. Today, this is the only way to implant teeth without first building up bone tissue.

Bone grafting during implantation: stages of surgery

Doctors have long noticed that the patient endures the operation much easier if he is well familiar with its stages. In this case, he knows what actions the surgeon will perform and is ready for it. To this end, we offer our readers the sequence of an average bone restoration operation:

Anesthesia. Osteoplasty is a manipulation that rarely has direct indications for the use of general anesthesia. However, if the patient is hypersensitive or impressionable, then the anesthesiologist can meet him halfway and administer shallow anesthesia. Usually, a few injections of local anesthetic are enough.
Periosteal flap incision, produced for the purpose of exposing the bone. Having exposed the bone, the surgeon assesses the extent of degeneration and the amount of transplant material required.
Direct build-up– the implementation of this stage depends on the chosen methodology.
Suture of the supragingival flap. In this case, the doctor usually uses self-absorbing threads that do not require further removal.

After the anesthesia wears off, the patient begins to experience quite pronounced painful sensations, which are not a deviation, since surgical intervention was performed. To weaken them, the doctor must prescribe oral painkillers and anti-inflammatory drugs, which should be taken for at least a week.

The operation takes place under local anesthesia.

Implantation of upper teeth with bone tissue augmentation: possible complications

Osteoplasty is an operation that is performed exclusively on the upper jaw due to the fact that other methods are used to restore the bone of the lower jaw. It is carried out at a short distance from the maxillary sinuses, and because of this, after its implementation, the following may begin to bother Problems:

chronic runny nose;
purulent inflammation;
separation of the bone block due to insufficient integration;
membrane exposure.

In addition, after surgery, the patient may experience high fever, chills and swelling - most often they are the body’s natural reaction to outside intervention, but sometimes they can be signs of incipient inflammation. That is why the doctor always schedules follow-up visits a few days after the procedure.

The side effects listed above often require complete removal of all implanted materials, treatment, and re-osteoplasty. To prevent this from happening, you should carefully prepare for the upcoming operation, following all the doctor’s instructions, and not neglecting the restrictions after the operation. Fortunately, complications occur quite rarely - their frequency is no more than 0.5-1%.

Prices in Moscow clinics

The cost of osteoplasty depends, first of all, on the complexity of the operation and what stages will be included in it - the patient can receive a final calculation only after consultation with the surgeon. Below is the cost of bone tissue augmentation in metropolitan dentistry using the example of a sinus lift (without the cost of tissue). Prices are given for bone restoration in the area required for the implantation of one tooth.

If a person has a tooth removed, changes begin in his jaw due to the absence of a chewing unit. The area of the jaw where the removal surgery was performed begins to shrink because the bone in that area is degrading. Preparation for dental implants often includes bone grafting, without which the installed prosthesis will not be able to hold firmly in the jaw.

Application of osteoplasty in dentistry

Osteoplasty is the artificial augmentation of bone tissue. The procedure is carried out before dental implantation, if a long period has passed since tooth extraction and the alveolar process has had time to atrophy. In this case, the patient may develop either horizontal bone resorption - a decrease in the width of the alveolar process, or vertical resorption - a decrease in the height of the process, or a combination of both forms of anomalies. If tissue is not built up, the cervical part of the prosthesis will protrude through the thin and low bone wall surrounding the implant.

Jaw tissue needs to be increased when:

The thickness of the vestibular (outer) wall of the jaw bone is less than 2 mm - after implantation, the prosthesis will be exposed and spoil the smile line.
The thickness of the wall between the prosthesis and the root of a healthy adjacent tooth or between two adjacent implants is less than 2–2.5 mm - after implantation, the interdental gingival papilla will degrade.

Jaw tissue atrophy

There are cases when dentists inaccurately remove teeth and severely destroy the structure of the tissues surrounding them. In such situations, plastic surgery is also a mandatory indication for implantation.

Advance bone tissue growth can improve the result of implantation, restore the normal structure of the jaw, prevent tooth displacement, disturbances in facial expressions and chewing. This procedure can be avoided only in cases where dentures are implanted almost immediately after tooth extraction or in the coming months after the procedure.

Bone grafting methods for dental implantation

You can grow bone tissue using several technologies:

Osteoplasty method	When to use	Peculiarities
To optimize the thickness of the alveolar process with developed horizontal resorption.	A relatively inexpensive method that does not require the use of expensive bone material. A very effective method of osteoplasty, as it provokes the natural processes of bone restoration. Implants are installed immediately or just 3-4 months after the procedure.
Bone block transplantation		An effective method with a predictable result, but it has a lot of disadvantages: bone blocks do not always take root; requires a long period of engraftment; The implant is installed only six months later.
Guided bone regeneration	Increase in the width and height of the alveolar process.	Simultaneous implant placement is possible. Insufficient survival rate was recorded due to tissue replanting from the outside, where there are few vessels.
Growth of bone tissue in height in the upper jaw - in its lateral part.	When increasing bone tissue through sinus lifting, simultaneous implantation is possible. With an open sinus lift, implants are placed only after several months.

More information about methods of increasing jaw tissue before implantation can be found in the video:

The procedure for building up the jaw bone for a dental implant

Bone tissue augmentation using the methods described above is carried out under local anesthesia, which, at the request of the patient, can be supplemented with an injection with a sedative. Anesthesia is necessary so that the patient does not feel discomfort when his gums, periosteum are incised and manipulations are performed to introduce bone material. The procedure lasts 1–2 hours.

After placing the grafting material, the doctor must apply sutures to protect the implanted tissue from possible infection and injury. Sutures are removed 10 days after surgery.

Features of bone tissue augmentation methods

When splitting the alveolar process, an incision is made in the gum and a cut is made in the central part of the process. Then holes are made for installing implants, into which spreaders are screwed. Implants can be inserted immediately. Bone material is placed on the side of them, and a special membrane and sutures are applied on top.

When grafting a bone block, a section of the grafted bone is taken from the patient himself (for example, from the maxillary zygomatic-alveolar ridge), from another patient with suitable indicators, or from bulls, but the survival rate of donor materials is much lower. The bone block is screwed to the jaw with screws and covered with a collagen membrane, after which sutures are placed.

For directed bone regeneration, different types of bone material are suitable: artificial, own, bovine bone, a combination of your own bone with bovine bone, donor bones. Tissue material is planted from the outside, and a barrier membrane helps form the jaw area and protect new cells from exposure to adverse factors.

Sinus lifting involves raising the floor of the maxillary sinus. With the closed tissue augmentation method, the doctor drills a hole between the jaw bone and the maxillary sinus and inserts a bone implant into it. With an open sinus lift, it makes a hole in the upper jaw, after which regeneration takes longer.

Features of the tissue healing period

Healing of bone tissue is a complex process, during which the body should be affected by as few negative factors as possible. Therefore, during this period, bans may be imposed on:

Flying on an airplane.
Diving.
Eating hot or very cold, too hard food.
Drinking drinks through a straw.
Heavy physical activity.
Visiting a bathhouse or sauna.
Blowing your nose.

After replanting bone tissue for implantation, colds are undesirable, so it is better not to carry out the procedure during epidemic periods.

A complete list of rules that must be followed after jaw tissue augmentation and the duration of their compliance should be obtained from the dentist who performed the operation. The list of restrictions can be expanded if additional difficulties arise during the healing period.

Judging by patient reviews, During the first days after surgery, swelling and cyanosis may occur around the area of extension. But after some time, in the absence of complications, the unpleasant symptoms disappear.

Contraindications to bone grafting in dentistry

Despite the need for bone augmentation for the implant to function properly, some patients are denied this dental service. Contraindications to osteoplasty are:

Uncharacteristic anatomical shape of the maxillary sinus.
Carrying out operations in the past.
Chronic rhinitis, sinusitis.
The presence of polyps or malignant tumors in the neck and head.
Tuberculosis.
Blood clotting problems and other hematological diseases.
Endocrine and immune disorders.
Poor anatomical condition of bone tissue.

Bone grafting of the lower and upper jaw is undesirable during pregnancy and lactation.

Smoking patients are advised to give up the habit at least temporarily, since nicotine provokes vasospasm, which reduces the rate of engraftment of implanted tissue. You should not smoke for several weeks before tissue augmentation and implantation surgery and for 4 months after the procedures. If extension and implantation are carried out at a time interval, the smoking ban applies twice.

If any contraindications are found, the patient may be offered alternative prosthetic methods to reduce the risk of developing undesirable consequences. The first method involves implantation into deeper layers of jaw tissue that are not subject to atrophy. The second is carried out with permanent prosthetics on a jaw completely devoid of teeth - 4 or 6 implants are installed in it, onto which a bridge with 12–14 crowns is attached.

Complications after bone augmentation in dentistry

Complications after osteoplasty are possible due to several factors:

Violations of technique for performing extension surgery, dentist mistakes.
Careless actions of dentists during implantation.
Low quality bone material used.
Low quality membranes used.

The following factors can provoke unpleasant consequences:

Exposure of the membrane from under the sutures, which causes purulent inflammation that requires urgent treatment.
Rejection of all the implanted bone material or some of its parts.
Retraction of the used materials into the maxillary sinus - surgery is required to remove them.
Marked loss of bone volume during healing, which may require reoperation.
Injury to the implanted bone and periosteum during implant installation.
The appearance of chronic runny nose.

How much does bone augmentation for implantation cost?

An important issue for all patients is the price of dental services for bone augmentation. Below are indicative prices. How much the procedure will cost in a particular case depends on the clinic, the material chosen, and the method of osteoplasty.

Osteoplasty methods	How much are
Bone augmentation for dental implantation using the method of splitting the alveolar process.	The cost of the service is from 15 thousand rubles. on the jaw area for 1–2 teeth, materials - from 3 thousand rubles.
Replantation of a bone block, taking into account the taking of one’s own bone material.	The cost of the service is from 36 thousand rubles, taking materials for the operation is from 13 thousand rubles.
Bone augmentation in the upper or lower jaw through guided tissue regeneration.	The cost of services on the jaw area for 1–3 teeth is from 25 thousand rubles, materials – from 25 thousand rubles.
Osteoplasty of the upper jaw using sinus lift.	Closed sinus lifting – from 10 thousand rubles, open – from 25 thousand rubles. excluding consumables.

Bone augmentation in the lower jaw is a necessary preliminary step before dental implantation for many patients. If the plastic surgery technology is followed correctly, the presence of contraindications is checked, and the patient adheres to the rules of behavior during the rehabilitation period, such an operation helps to improve the condition of the dentofacial apparatus. To avoid problems that may arise with installed implants, you need to choose experienced specialists in the field of dental surgery.

To find out how to save on osteoplasty before implantation, watch the video:

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Implantation in dentistry is the most modern method of prosthetics, and if a tooth has been removed recently, it does not cause virtually any difficulties and does not require additional costs or manipulations. Often, people who have been missing teeth for at least a year, and often more than ten years, resort to implantation. During this time, without the necessary load, their bone tissue decreases significantly, and the installation of classic root-shaped implants becomes impossible. In this situation, the most rational solution is bone tissue augmentation.

Bone augmentation during dental implantation

Bone augmentation surgery involves adding material to existing bone to stimulate its growth. In various cases, installation of an implant is possible either simultaneously with bone grafting, or, in case of severe atrophy, after four or six months, when the implanted stimulator causes normal blood vessels and nerve endings to grow through the bone tissue. After this, the new bone strengthens and is ready to accept the chewing load, which in an adult ranges from 50 to 300 kg.

Bone tissue augmentation for implantation in the upper and lower jaws has its own characteristics due to the different bone structure, as well as the location of nearby organs, tissues, vessels and nerves.

Bone augmentation in the lower jaw

Difficulties in growing bone tissue in the lower jaw lie in the close location of the mandibular canal, which contains a large nerve, artery and vein. If the height of the bone above the inferior alveolar nerve is less than 10 mm, there is a high probability of damaging it with the implant. In some cases, during implantation, microsurgery is performed to slightly move the nerve. This requires 3D modeling of the operation based on the results of computed tomography.

In Russia, a technique of autograft transplantation is often used, in which material is taken from the chin or from the area near the last molars. The block is fixed with titanium screws, and the gaps are filled with bone shavings with hydroxyapatite and covered with a collagen film. After 5–6 months, the screws are removed and the possibility of installing an implant is assessed.

Important! In our Center, this technology is not used due to the transition to BMP technology (non-traumatic, controlled stimulation of native bone growth without transplantation of fragments).

Bone augmentation of the upper jaw

This procedure is also associated with certain difficulties. The so-called sinuses, or maxillary sinuses, are located nearby. They literally lie on weakened bone. Lifting and peeling them off must be done extremely carefully, which can only be done by a qualified maxillofacial surgeon. It is to him that we recommend contacting if this operation is necessary.

A sinus lift is performed on the same day under local anesthesia or, if the patient is too sensitive and anxious, it is possible to use sedation, which calms but does not turn off the patient’s consciousness. Medication-induced sleep is not anesthesia with all its inconveniences, but a modern safe technology for comfortable performance of modern high-tech operations. The average duration is 40 minutes, then you can safely go home in your own car.

Complications and risks

Unprofessional management and non-compliance with the protocol for bone augmentation surgery leads to various troubles, the undoubted hits among which are infection, which can lead to rupture of the membrane, perforation of the mucous membrane of the maxillary sinus, exacerbation of chronic purulent sinusitis or sinusitis. Inflammation of the maxillary sinuses may also occur. Careful implementation of the procedure, the experience and attentiveness of the doctor reduce possible complications to zero. Reduces risks and 3D design on a virtual model.

Sometimes patients regard normal postoperative conditions, such as minor pain, swelling or moderate bleeding, as postoperative complications. If the swelling and other symptoms after surgery go away after three days and there is not too much bleeding, there is nothing to worry about. If pain and swelling persist, you should immediately consult your doctor.

Note! After bone tissue augmentation in our Center, patients receive a brochure with recommendations and the contact number of the responsible specialist, as well as a set of medications for correcting conditions in the postoperative period.

our team

If you refuse to augment bone tissue, the following risks arise:

Unreliable fixation of root-shaped implants of the correct length and width.
The threat of weakening of the bone due to the heavy chewing load that will fall on it after installing the crown on the implant.

Bone augmentation for periodontitis

When periodontal tissue becomes inflamed, bone loss threatens tooth loss. One of the methods used in the complex treatment of the disease is directed regeneration techniques. They allow you to restore lost bone height and permanently prevent the occurrence of local osteoporosis.

Preparations for bone tissue building

Various materials are used as preparations. Previously, it was believed that it was best to engraft one’s own tissue taken from another part of the jaw, but taking one’s own bone material is another operation, and a rather traumatic one at that.

Our Center uses natural preparations and BMP technologies that do not require the collection of the patient’s own tissue. These are growth stimulants, thanks to which your own bone is naturally restored to the desired size in a predictable way. After this, you can install a root-shaped implant, and it is guaranteed to last a lifetime. In other conditions (if the patient refuses the necessary bone grafting or the use of other types of implants), it is impossible to provide a lifetime guarantee for implantation.

Patient reviews

Patient

I would like to thank Victoria Mikhailovna Ostankovich! Doctor from God! She did a great job on my teeth. I was very lucky with her. Victoria Mikhailovna calmed me down and did everything possible so that I would no longer have complexes. Great specialist! Thank her very much!

Lack of bone volume in the area of the dental defect is one of the most common relative contraindications to implantation. According to statistics, 70% of dental implants are installed in conditions of jawbone atrophy of varying severity. To solve this problem, many patients are prescribed one or another type of bone grafting.

Why is there a need for bone grafting?

The roots of natural teeth are located in the spongy part of the jawbone called the alveolar process. This area of the jaw is riddled with blood vessels and nerves. The parameters of the alveolar processes are not constant values and change under the influence of various factors - the intensity of the chewing load, traumatic tooth extraction, endocrine or systemic diseases of the joints and bones. Let's consider how the lack of chewing pressure affects the jawbone due to tooth extraction.

The roots of natural teeth, thanks to the constant chewing load, keep the alveolar processes in good shape. When one or more teeth are lost, the jawbone in the area of the dentition defect ceases to experience pressure and gradually atrophies. Loss, or resorption, of bone begins several months after tooth extraction and can continue until the original volume is completely lost.

Depending on the location of the defect, bone tissue resorption occurs in different ways. Due to the fact that the density of the tubular bone in the upper jaw is several times lower than in the lower jaw, atrophy of the upper alveolar process occurs much faster. So, if in the lower jaw the process of bone shrinkage starts after 6-12 months, then in the upper jaw – already 2-3 months after tooth extraction.

Dentists distinguish the following types of bone atrophy:

The alveolar process is reabsorbed across its width (horizontal atrophy).
The alveolar process is absorbed in height (vertical atrophy).
Resorption occurs in width and height simultaneously (combined atrophy).

Depending on the direction, degree and localization of resorption, various technologies are used to build up bone tissue for a dental implant. The chosen bone grafting technique, in turn, determines the type of osteoplastic material for bone augmentation.

Materials for bone tissue augmentation during implantation

In implantology, osteoplastic materials are used in the form of granules, bone blocks and porous membranes. There are osteoplastics of mineral (synthetic) and biogenic (animal) origin.

To build up the jawbone during implantation, the following types of bone material are used:

Autogenous - a piece of bone extracted from the donor area of the patient himself. The bone placed in the defect area is called an autograft.
Allogeneic – the bone donor is another person. Allografts are taken in the event of a person's death, undergo special processing and are stored in donor tissue banks. Despite the ethical issues, allografts have a significant advantage, saving the patient from surgery to harvest his own bone tissue.
Xenogeneic – material of animal origin based on bovine or pork bone. Used in the form of granules and bone blocks.
Alloplastic - granules of synthetic origin based on calcium phosphate.

A separate group of osteoplastics consists of collagen membrane plates of animal origin. The main purpose of the membranes is to isolate the bone defect from the soft tissue of the gums and actively stimulate the repair of the jaw bone.

Types of bone grafting for dental implantation

To restore lost bone volume and install an implant, 4 technologies are used.

1. Splitting of the alveolar process

Description of technology: the alveolar process in the area of the dental defect is sawed along the ridge with a dental cutter (1). The resulting hole is expanded with drills of different diameters (2,3), after which root-shaped implants are screwed in (4). The remaining cavities on both sides of the rods are filled with a synthetic or natural osteoplastic filler, covered with a resorbable membrane (5), and the gingival flap is sutured.

3-6 months after tissue regeneration is completed, abutments and temporary dental crowns are installed on the implants.

In the photo: Bone tissue augmentation before implantation by cutting the alveolar process

Indications: This bone grafting technology is used to restore several teeth with horizontal resorption of the alveolar process at least 2 mm thick.

Important: The method allows for bone grafting to be performed simultaneously with dental implantation, promotes rapid regeneration of bone tissue, and does not require surgery to collect autogenous bone material.

2. Bone block transplantation

Description of technology: the operation is carried out in two stages.

At the first stage, donor bone is collected from the chin area, from the cusps of missing wisdom teeth in the upper jaw, and in rare cases, from the ilium.
At the second stage, autogenous bone material is placed in the desired area of the jaw using titanium screws. After this, the regenerated area is covered with a two-layer resorbable membrane and hidden under a gum flap.

Indications: restoration of one or more teeth with severe bone resorption in width or height.

Important: Using your own bone significantly increases the chances of successful regeneration of the implanted block. This type of bone grafting does not allow you to immediately proceed to implantation. The implant is installed only 6-12 months after the first operation.

3. Guided bone regeneration

Description of technology: (see the process in the photo below) The gums are opened (1), after which the area is injected with natural osteo-replacement material based on bovine bone (4). The area is covered with a two-layer collagen membrane (5) to guide bone regeneration and sutured (6). Instead of a resorbable membrane, a non-resorbable film on a titanium mesh frame can be used.

In the photo: Guided bone regeneration simultaneously with the installation of 2 implants

Indications: used for minor and moderate atrophy of bone tissue in width and height.

Important: the augmentation can be carried out simultaneously with the installation of the implant and does not require surgery to transplant a bone block.

4. Sinus lift

Description of technology: During the operation, the dental surgeon lifts the bottom of the maxillary sinus and fills the resulting cavity with a synthetic bone filler. Depending on how the manipulations to correct the bottom of the maxillary sinus are carried out, a distinction is made between closed and open sinus lift.

Indications: the upper jaw in the area of 5-7 chewing teeth with the close proximity of the maxillary sinuses.

Important: In most cases, implantation in the upper jaw is performed simultaneously with a sinus lift.

Prices for bone tissue augmentation during dental implantation in Moscow

The cost of the operation is determined by the following factors:

Degree of bone tissue atrophy;
Selected augmentation technology;
Materials used.

A little about the cost of consumables:

Let's give an example of how the cost of augmenting bone tissue for an implant will change depending on the type of materials used.

* The membrane is used only in some cases.

We do not skimp on consumables, and to guarantee our clients the success of the operation, we use only experience-tested, expensive materials.

Cost of bone tissue augmentation for implantation at the NovaDent clinic

How to do without bone grafting

The NovaDent dental center offers clients several alternatives to bone grafting. To avoid complications and if there are appropriate indications, we can perform dental implantation without bone tissue augmentation in the following ways:

install compression-type implants into deeper layers of bone;
install long root-shaped implants at an angle to the plane of the tooth or bypassing the maxillary sinuses;
carry out a full jaw implantation on four or six implants.

The choice of treatment method is determined by the attending physician based on the results of the initial consultation and examination of the patient.

Quite often, when planning implantation, a stage of bone tissue augmentation or augmentation. Most people call this stage bone grafting.

Augmentation can be vertical, horizontal and combined. It is performed on both the upper and lower jaws.

Bone grafting for dental implantation

Bones of the upper and lower jaws in their structure have basal and alveolar parts or processes, it is in the alveolar parts that the teeth are located. When teeth are lost, processes are lost in varying amounts.

Augmentation aims to restore lost bone. This is a difficult and crucial moment of the implantation stage. For this, so-called bone grafts are used. They are:

Autogenous: from your own bone tissue.
Allogeneic: cadaveric origin.
Xenogeneic: animal origin.
Alloplastic: synthetic materials.

They are also used in various types resorbable(absorbable) and non-resorbable(non-absorbable) membranes for covering the graft.

Indications

The main reason for osteoplasty is bone deficiency caused by bone atrophy due to tooth loss. With edentia (absence of teeth), gradual atrophy occurs - a decrease in tissue volume as a result of loss of load. Bone loss occurs in both width and height. An important condition for implantation is the presence of bone tissue into which the implant will be installed. The thickness of the bone surrounding it should be not less than 2 mm.

Bone augmentation before implantation

An implant is an artificial root. All products have their own size range in diameter and length. Depending on the group of teeth being restored, one or another size and length of the implant is required.

It is important to take into account presence of anatomical formations in the thickness of bone tissue, such as the inferior alveolar and mental nerves in the lower jaw, the maxillary sinuses, the nasal cavity and the incisive canal.

Therefore, when there is no required bone size corresponding to the implant, operations such as sinus lifting, guided bone regeneration, block transplantation, neighbor augmentation.

How it happens

Depending on where the extension is required, There are several techniques for restoring alveolar bone using bone replacement grafts and membranes:

All types often combined with each other.

How does dental implantation work if there is no bone tissue?

It is not entirely correct to say that there is no bone tissue for implantation. She there is to one degree or another. It is more correct to talk about real conditions for the possibility of implantation.

Thus, with a large loss of alveolar parts in the lower jaw and the difficulty of bone grafting, they can be used basal implants. But they are not a classical method and are not so popular among implantologists.

If there is a deficiency of bone tissue in the upper jaw and it is impossible to carry out classical methods of augmentation, basal implants can also be used. In addition, there is Zygoma zygomatic implantation technique.

Stages

Quite often there are conditions in which bone tissue atrophy is insignificant. In this case, there is a basis for performing bone grafting simultaneously with the placement of the implant. The operation includes several stages:

Carrying out the operation

Several augmentation techniques have already been given above. When pre-forming the conditions for the procedure The same steps are carried out as with implant installation. As a rule, more than one graft is used. Most often, graft mixes are used, one of which must be autobone(bone of the patient himself). Both resorbable and non-resorbable membranes are used as coating; the latter are removed at the stage of implant placement. The membranes are fixed with pins or screws to stabilize the graft.

How long does it take to place implants?

The time of integration (increment) of a material depends on its origin. But the operation of dental implantation on pre-formed bone is performed no earlier than six months later. And in some cases up to nine months.

Photo 3. Jaw before implantation (left) and after surgery (right). Implants are placed after the gums have completely healed.

Gum plastic surgery

We must not forget that in the process of bone tissue atrophy, atrophy of the mucous membrane covering the bone.

Attention! The presence of a certain volume of soft tissue around the implant is an important condition for long-term forecast of product survival.

All biological aspects of implant prosthetics must be observed. And in addition to plastic surgery of bone tissue, it is necessary to perform plastic surgery of soft tissues, follow the principles of “pink aesthetics”.

How to grow gums

As with bone material, grafts are used to compensate for soft tissue deficits. Only in 95% of cases The patient's own tissue is used as grafts. The donor sites are the mucous membrane of the human oral cavity from the area of the palate, maxillary tuberosities, and the retromolar area on the lower jaw.