Replenishment of lost bone volume. Bone grafting

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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!

Section “Dental implantation” on the website

After tooth loss, bone atrophy develops after 3 months. In addition, long-term inflammatory diseases of the oral cavity, anatomical features, age-related changes, congenital anomalies, various injuries of the maxillofacial area, tumor processes in the jaws, general diseases and more can contribute to bone atrophy.

But with the current level of modern dentistry, this should not be too frustrating. After all, there are implantation methods that are possible even with a lack of bone tissue without first building it up. For this purpose, the following types of implantation are used:

transosseous implantation- used for severe atrophy of the lower jaw.

The process of implantation is that an arched bracket is installed on the lower edge of the body of the lower jaw by extraoral surgery. Two implant pins are inserted through the bone, and are then used to secure removable dentures.

submucosal implantation are used primarily to stabilize complete or partial dentures. It consists of installing intramucosal implants, which make it possible to dispense with the need to insert a prosthesis into the bone tissue.

This type of implant looks like mushroom-shaped protrusions. When applying the prosthesis, they enter the corresponding depressions in the mucous membrane.

mini implantation- this is a technology for reliable fixation of complete removable dentures, which has practically no contraindications with the exception of: severe general condition of the patient, cancer (during radiation therapy), diabetes, suppression of the immune system, diseases for which any surgical intervention is contraindicated. The patient's age is not a contraindication for the installation of mini implants.

This technology allows you to securely fix the removable denture and achieve sufficient load on the jaw bone tissue, which prevents its atrophy. When using this implantation technology, the prostheses do not rub the mucous membrane and there is no need to constantly adjust the shape of the prosthesis.

Installation of mini implants does not require dense bone tissue or a wide and high alveolar ridge.

Installation of mini implants is carried out within a few minutes using minimally invasive surgical techniques.

subperiosteal implantation- used for severe thinning of the jaw bone tissue.

This type of dental implant is placed under the gum, between the periosteum and the bone. The design of such implants is quite thin and delicate; it is a metal frame with supports protruding into the oral cavity, which allows it to be firmly held and effectively perform its function. This type of implantation is usually used when the height of the alveolar part of the jaw is insufficient.

intradental-intraosseous implantation- in which implants are installed into the bone tissue through the apex of the tooth root.

Thanks to this installation, there is no significant trauma to the mucous membrane, so the healing process can occur faster and more efficiently.

Typically used to lengthen and strengthen the tooth root, which gives additional stability to the entire structure.

This implantation is widely used to eliminate tooth mobility in case of periodontitis and periodontal disease, with severe destruction of the tooth crown, as well as to give stability to teeth in the remote apex of the tooth root.

transosseous implantation- used in cases of severe atrophy of the lower jaw bone.

In this case, an arched bracket is placed on the lower jaw. After this, two through implants are installed in the form of pins. Implants protrude into the oral cavity, allowing removable dentures to be attached to them.

What type of implantation you need can be clearly determined by a highly qualified dentist after appropriate examinations, 3D tomography, etc.

From this article you will learn:

how is bone grafting performed in dentistry,
bone grafting methods – price 2019,
Jaw bone augmentation for a dental implant: reviews,

After tooth extraction, bone tissue undergoes gradual atrophy, which leads to a decrease in the width and height of the bone at the site of missing teeth. Bone grafting during dental implantation (synonyms - bone augmentation, bone augmentation) - allows you to increase the volume of bone tissue at the site of implant installation.

Bone tissue augmentation during dental implantation, reviews from implantologists indicate that it is necessary not only for the normal functioning of the implant (from the point of view of bearing the chewing load), but also for aesthetic reasons. The fact is that too thin bone walls around the implant are always subject to resorption, and as a consequence of this, gum recession occurs and the implant neck is exposed.

Optimal bone thickness around the implant –

The most important points (according to Fig. 1) –

1) Firstly– the thickness of the vestibular bone wall (i.e., the one located on the side of the lip/cheek) should be at least 2.0 mm, and 2.5 mm is very good. If the front surface of the implant is covered with bone less than 2 mm thick, this means 100% bone resorption around the implant neck, accompanied by lowering of the gum level and exposure of the implant neck. In this case, the implant will still bear a functional load, however, if it stands in the smile zone, the gum contour around the implant will become aesthetically unacceptable over time.

2) Secondly– the thickness of the bone wall between the implant and the root of the adjacent tooth should ideally be 3 mm, but 2.5 mm is tolerable. If this distance is less (for example, 1.5-2.0 mm), then the following problem arises. Even under normal conditions, slight bone resorption is always observed around the neck of the implant. If the bone partition between the implant and the tooth root is too small, then bone resorption will also occur at the surface of the root adjacent to the implant. This means lowering of the gingival level and absence of the interdental gingival papilla (i.e. poor esthetics).

3) Third– the thickness of the bone wall between two adjacent implants should ideally be 3.0 mm. If it is less, then, as in the previous case, this means significant resorption of the bone septum between the implants, and as a consequence of this process - receding gums in this area, absence of the gingival papilla, exposure of the implant (i.e. poor aesthetics).

Causes of bone deficiency:

1) The main reason for the decrease in bone tissue volume is the natural resorption (resorption) of bone in the area of extracted teeth. This happens because the bone loses support in view of the tooth root, and also because chewing pressure ceases to be exerted on the bone tissue. As a consequence, there is a decrease in bone volume, which can occur both in height and in width of the alveolar process of the jaw.

2) The second reason is traumatic injuries caused by dental surgeons. Usually, during removal, the surgeon does not think at all about the safety of the bone walls of the alveoli around the tooth, biting them off with forceps. If you are planning extraction followed by tooth implantation, then it is best to carry out such removal by an implant surgeon, who will try to preserve the bone tissue as much as possible.

There are 3 types of bone resorption –

horizontal resorption (Fig. 2), when the width of the alveolar process decreases,
vertical resorption (Fig. 3), i.e. when there is a decrease in the height of the alveolar process,
+ combined form.

According to the type of resorption in a particular patient, a bone grafting technique is selected, aimed at increasing the width and/or height of the alveolar process of the jaw.

Bone grafting for dental implantation: reviews

There are many different bone grafting techniques, but they can be divided into 2 large groups. Firstly, horizontal bone augmentation techniques aimed at expanding the narrow alveolar process. Secondly, vertical bone augmentation techniques aimed at increasing the height of the alveolar crest.

Most commonly used techniques –

splitting of the alveolar process,
bone block transplantation,
technique of guided bone regeneration (GBR),
sinus lift method (used for insufficient bone height in the lateral parts of the upper jaw).

All these operations are performed under local anesthesia; if necessary (at the patient’s fear), intravenous sedation can be performed. The duration of the operation can be from 1 to 2 hours, which will depend on the technique used, the volume and complexity of the operation. The stitches are removed on the 10th day.

Important : all methods have their pros and cons... Histological studies have shown that after bone augmentation using different methods, a completely different structure of the newly formed bone tissue is observed, which can lead to subsequent resorption of the new bone. In addition, a lot depends on the nature of the bone material being implanted.

1. Splitting of the alveolar process –

Used in horizontal bone resorption to increase the thickness of the alveolar process. Can be performed on both the lower and upper jaws. It must be said that this is the most effective method of expanding the alveolar process today, which also has a low cost (it does not require expensive bone materials and membranes). There are several varieties of such splitting, but we will especially focus on the “Split-Control” technique, which allows for simultaneous expansion and installation of implants.

Contents of the Split-Control technique(Fig.5-10) –
after detachment of the mucoperiosteal flaps (gum), a cut is made in the center of the alveolar ridge with a milling cutter or other special instruments to the height of the future implant (Fig. 6). Next, a pilot drill is used to mark a hole for the implant(s) and spreaders are screwed into the prepared holes (Fig. 7). By using different sizes of spreaders from smaller to larger, you can increase the width of the ridge and immediately install the implant.

There is always a gap left on the sides of the implant, which is filled with bone material, which, if necessary, can be applied in excess to the outside of the alveolar process, covering it all with a special resorbable membrane (Fig. 9). After which the wound is sutured, and we wait for osseointegration of the implant within 3-4 months.

Bone grafting of the lower jaw (splitting method) –

Advantages of the technique –

Firstly– thanks to the splitting of the ridge, we get a bone defect that has bone walls on all sides (except on top). Thanks to this, rapid and high-quality osteogenesis (new bone formation) occurs, because the spongy bone deep in the alveolar process is rich in blood vessels, osteoblasts, mesenchymal cells, growth factors...
Speaking of why it is much worse to increase the width of the bone not through splitting (from within the alveolar process), but to do this through external attachment of bone blocks or bone chips outside the cortical plastic surgery of the alveolar process. The fact is that the outer cortical layer of bone is very dense and there are practically no blood vessels in it. Accordingly, the implanted bone material will take a very long time to grow blood vessels, bone formation will be slower, and there will be a greater risk of failure and complications of such bone grafting.

Secondly– there is no need for expensive bone materials and membranes, again due to the fact that this is a three-wall defect inside the alveolar process, and not outside it. There are enough inexpensive materials here, for example, the bone material "Osteodent-K" and the membrane "Osteodent-Barrier"..

Third– installation of implants with this technique is in most cases possible immediately. If the implants are installed later, then only 3-4 months will have to pass between operations, which is significantly less compared to other bone grafting methods.

Splitting of the alveolar process: animation and video of the operation

Important : There are several types of splitting techniques. With “Split-Control”, the cutter makes only a cut along the crest of the alveolar process + a pair of vertical cuts to the thickness of the cortical plate. But there is a variation of this method, where an additional horizontal cut is made at the level of the tops of future implants, which leads to complete detachment of the bone block (vestibular cortical plate).

Then this block is fixed with screws, which often break it. With this modification of the technique, implants are not installed immediately, but after 3-4 months. In addition, it is quite traumatic and there is a greater risk of complications. This type of technique should only be used for the thinnest alveolar process (2 mm), but some doctors use it even in cases where this is not necessary.

2. Bone block transplantation –

This method can be used both to increase the width of the alveolar process and its height. This technique predominantly uses an autogenous bone block (this means that the bone block is taken from the patient himself in other areas of the jaws). The block can be collected in the area of the tubercle or zygomatic-alveolar ridge of the upper jaw, or in the area of the ramus or mental area of the lower jaw. Bone blocks of allogeneic origin (from another person), as well as xenogeneic origin (bovine bone), are less commonly used, which is associated with their much lower efficiency.

Example of a bone block transplant operation –
In photos 11-16 you can see an example of how bone grafting of the upper jaw (in the area of the central incisor) is performed using two bone blocks. Please note that 2 blocks were used because in this case it was necessary to increase both the width and height of the alveolar process in the area of the extracted tooth.

Bone blocks are first screwed to the bone using special titanium micro-screws (Fig. 12). The block can be additionally covered with bone shavings, after which the blocks and surrounding bone tissue are necessarily covered with a collagen membrane (exactly the same as those used for the guided bone regeneration technique). The membrane is fixed to the bone using special metal pins (Fig. 14), and after this the mucous membrane over the operation site is sutured tightly.

Bone block transplantation: animation and video of the operation

Pros of this method –
This is an excellent method for increasing bone volume with predictable results. The gold standard when using this method is the use of an allograft (a bone block taken from the patient himself). Moreover, it is very important that the graft being transplanted is “cortical-spongy”, i.e. had not only a cortical plate, but also cancellous bone tissue. In this case, you can get a predictable and positive result from a bone block transplant.

Disadvantages of this method –

Additional surgery is required to remove the bone block.

Secondly, with this technique, the possibility of simultaneous installation of implants is most often excluded, because this greatly increases the risk of rejection of both the implant and the bone block itself.

Thirdly, such bone blocks require longer engraftment, i.e. After such an operation, it will be necessary to wait about 6-8 months before installing implants at all. This is because the bone block is screwed to the outside of the jaw. The superficial cortical layer of the jaw bone has very few vessels, and therefore the growth of vessels into the transplanted bone block occurs very slowly.

Fourthly - again due to the slow growth of the bone block by blood vessels (during the subsequent installation of the implant at the second stage) - sometimes the bone block can be separated from the jaw due to its insufficient integration with the bone tissue of the jaw.

3. Guided tissue regeneration (GTR) –

This method can also be used to increase both the width of the alveolar process and its height. In addition, if the lack of bone tissue volume is not critical, then simultaneous installation of implants is possible along with bone grafting. However, the method also has its drawbacks, which we will discuss below.

Directed tissue regeneration (synonymous with directed bone regeneration) involves the use of two components: firstly, implanted bone material, and secondly, a special barrier membrane, the use of which will isolate the bone defect from the effects of adverse factors.

Guided bone regeneration: examples of operations

1) Clinical case No. 1 –
Photo 17 (in the area of planned implantation) shows a significant bone defect, which will be filled using a bioresorbable membrane and Bio-Oss bone material. In photos 21-22, taken 5 months after inert grafting, you can see the installation of the implant in this area...

2) Clinical case No. 2 –
using guided bone regeneration techniques simultaneously with the installation of implants. The materials used were the inert material “Bio-Oss” and the resorbable membrane “Bio-Gaid”...

Importance of Barrier Membrane –
the barrier membrane performs the following functions: it allows you to give the desired shape and volume to the area of bone tissue being built up, protects the grafted bone from being absorbed by osteoclast cells (located in the periosteum), prevents the mechanical impact of the soft tissue of the gums on the grafted bone material and its deformation...

There are different types of membranes, resorbable (Bio-Gaid), non-resorbable (Gore-tex or titanium mesh membranes). The former dissolve on their own over time and do not need to be removed, but they hold their shape much worse compared to mesh titanium membranes or membranes with titanium reinforcement. All these membranes are expensive, but the use of cheap membranes (such as Osteoplast) is not suitable for this technique.

Selection of bone material –
There are many different materials: based on synthetic hydroxyapatite, biopolymers, tricalcium phosphate, bioglass, based on bovine bone, etc. Below we will focus on the most effective types of bone materials (in descending order of their effectiveness).

Use of bone autograft –
Autograft should be understood as bone material that is taken from the patient himself in other parts of the jaws (for example, in the form of bone chips or a bone block). There is only one downside - the need for an additional small intervention to collect bone material.

Combination of autograft + xenograft –
in a 1:1 ratio, bone shavings (taken from the patient) are mixed with material of xenogeneic origin, i.e. based on bovine bone. An example of this is such high-quality and effective material as “Bio-Oss”. This is a very effective combination for increasing bone volume.

Allograft use –
This type of bone material is also very effective, but is used much less frequently. The fact is that the source of bone material in this case is cadaveric material (of other people). These materials are purchased from a special tissue bank; all materials undergo careful processing and are completely safe, but for psychological reasons they are used less frequently.

Use of pure xenograft –
“Bio-Oss” material (based on bovine bone) can be used without mixing it with the patient’s own bone chips, but then the efficiency of bone augmentation will be lower.

Guided bone regeneration with simultaneous implantation: video of the operation

Video 1 – using Bio-gaid resorbable membrane,
video 2 - using a mesh titanium membrane.

Important : It should be noted that this method is not always quite effective. The fact is that the bone material is “planted” outside the cortical plate of the jaw (a very dense surface layer of bone). The newly formed bone differs in structure from the native jaw bone, does not have its own cortical plate on the outside and therefore has a tendency to subsequent partial resorption.

Therefore, it is necessary to carry out bone augmentation using this method “with a reserve” for the planned degree of future resorption, which will be more pronounced the thinner the gum biotype (gingival thickness). This is due to the fact that the surface layers of the bone will receive less oxygen and nutrients due to their less blood supply.

Bone tissue augmentation during dental implantation: price 2019

How much does it cost to build up the jaw bone for a dental implant in 2019? Augmentation of bone tissue for implantation - the cost will differ from the type of technique and the volume of the operation (in the area of how many teeth it is performed), as well as from the type and volume of bone material and membrane used.

Quite often, dentists and their patients have to deal with bone tissue buildup during dental implantation. We will provide the price, reviews and a detailed description of the procedure below.

This happens in cases where a person has spent too much time thinking about whether to install implants. During the absence of dental units, hard tissue atrophies too quickly, which leads to the need for bone grafting.

About the patient's lack of bone tissue

As soon as a tooth falls out or is removed, a natural and irreversible process begins - tissue atrophy. Doctors say that already within a year of the absence of a dental unit, resorption reaches its maximum.

If the patient needs to have an implant implanted to restore the integrity of the row, then the lack of natural bone will become a significant obstacle. It is believed that for high-quality implantation you need at least 10 mm of solid base.

And when it is not enough, you have to use the procedure of bone tissue grafting. In this case, a special operation is performed in which the bone is built up to the required volume. This procedure significantly increases the restoration time of the dentition, but provides high-quality and long-lasting results.

A very important point is that in order to avoid any unpleasant complications, you should choose a good clinic, an experienced doctor and adhere to absolutely all the rules of preparation for the operation.

Why is the procedure necessary?

In the absence of bone tissue, it is necessary to build it up. And this applies not only to cases of subsequent implantation, but is also done to solve other problems:

For sufficiently reliable fastening of the implant if the bone is shorter than the artificial rod.
To prevent tooth displacement, loosening, loss and other dental pathologies.
Prevent distortion of facial expressions and articulation.
Restore chewing function, which inevitably occurs with atrophy.
Prevent facial contours from becoming distorted due to jaw reduction.

Doctors highlight the following advantages of the process when adding artificial bone material or growing it in another way:

Complete restoration of all jaw functions, even if the atrophy has reached a large extent.
Makes high-quality implantation available, in which the rods will stay in place for a long time and reliably.
The attractive appearance of the gums returns, and after prosthetics, the entire dentition.
Following the rehabilitation period, all the inconveniences that accompanied tooth loss and bone atrophy completely disappear.

True, there are also some disadvantages of the procedure, such as the long recovery stage, the operation process itself, and partial restrictions on this time. Building and increasing bone tissue is a complex, long-term and always joint work of the patient and the doctor. Only with coordinated actions can all the positive effects and expected results be achieved.

Photo

Options for bone tissue augmentation during dental implantation

Depending on the condition of the bone, the health of the patient, the expected result and the practical skills of the doctor, various procedures can be performed:

Guided tissue regeneration, otherwise GTR. During the scientific and technological process, the doctor implants a special membrane. It is made of biocompatible material and promotes natural tissue growth. Such a membrane may or may not be absorbable. After its installation, the surface of the wound is sutured and a certain period is waited until the bone grows to the desired size.
Bone block grafting. When grafting a bone block, a piece of the patient’s own bone is most often used. It is usually taken from the chin. This results in two wounds, which is considered a disadvantage of the procedure. But such a transplant takes root better and does not cause rejection. This bone is screwed with special screws into the desired place, compacted with shavings or granules and sutured with a membrane. It is this that will prevent them from being washed out and will contribute to rapid regeneration. Another disadvantage of bone block implantation is the length of time and the procedure being performed several times. After all, initially they make two injuries, and then they perform an additional operation to remove the membrane and implant a pin.

Whichever bone grafting option is chosen, the operation goes through certain stages for which the patient must be mentally prepared:

Mandatory health examination, determination of the degree of atrophy using x-rays. Taking blood tests with advanced interpretation. After all, the operation should be performed only in the absence of any contraindications.
Anesthesia. Most often, local anesthesia is chosen, but in rare cases of increased sensitivity or impressionability of the patient, the doctor may choose light general anesthesia.
A periosteal flap is incised to expose the remainder of the natural bone. In this case, the doctor can additionally diagnose the condition and extent of atrophy. Accordingly, the required material for extension and its adequate quantity are selected.
Next comes the procedure itself, which will differ depending on the chosen plastic surgery method.
After all the manipulations, the doctor is obliged to suture the bone with the installed components and secure the wound. Absorbable sutures are most often used for this procedure, so removing sutures will be unnecessary.

After the operation, the dentist will definitely advise you on what can be done and what should not be allowed. It is very important to follow these recommendations to avoid any consequences.

If the operation is successful, the rehabilitation period will last up to a month. During the first week, you also need to take painkillers and anti-inflammatory drugs.

Sinus lift

This is the most popular procedure, which is carried out in two ways - open and closed. The doctor decides which one is better to choose based on the diagnosis of the condition of the bone tissue.

In this case, mechanical lifting of the maxillary sinus is performed so that the necessary tissue can be built up underneath it. But this method is used only if you need to increase it by 1-2 mm, no more. Also, a limitation for a closed operation is the absence of no more than two teeth in a row.

Otherwise, either an open procedure is performed, or a completely different method of bone grafting is chosen.

Indications for sinus lift are:

Absence of any pathologies at the site of the procedure.
The presence of a certain amount of bone tissue to perform the necessary manipulations.
When diagnosing the patient’s health, nothing was found that could provoke complications after the operation.

It is also important to ensure that the patient does not have the following problems:

The presence of several partitions in the sinuses themselves.
Polyps in the corresponding area.
Constant runny nose for various reasons.
Sinusitis in any form.
Broken or weak bone.
Previous surgical interventions in .
The patient has a bad habit in the form of frequent smoking.

Open

An open sinus lift is a complex operation that is performed only in extreme cases. The following manipulations are carried out:

The doctor drills a hole in the wall of the maxillary sinus, trying not to touch the mucous membrane.
The shell itself is raised to the desired height.
The entire opened space is filled with a special material that will stimulate bone tissue growth.
The wound is closed and sutured, returning everything that was moved during the operation back into place.

Only over time, when the tissue has grown to the desired size, is implantation performed.

Closed

A closed sinus lift is completely different, in which the direct installation of implants becomes possible simultaneously with the implantation of tissue. The procedure is convenient because it is carried out in one go. The following stages are distinguished:

Initially, the bone bed is prepared where the implant rod will be installed. Its size should be 1-2 mm less than the maxillary sinus.
Using a special tool and light tapping, the doctor moves the desired fragment deeper, thereby lifting the mucous membrane to the required height.
Osteoplastic material is introduced through the created hole and at the same time the implant rod is installed.

While tissue healing and gum formation are taking place, the patient may be offered to use plastic temporary structures that will imitate the dentition for the period until permanent implants are created and installed.

Although this procedure is considered simpler, more accessible and less traumatic for the patient, if it is carried out incorrectly, some unpleasant consequences may arise:

Damage to the sinuses, which will lead to chronic runny nose.
Possible sinking of the entire structure, followed by its forced removal.
The occurrence of inflammation in the maxillary area, which will have to be cured and only after that the implantation procedure will be repeated.

To prevent this from happening, the patient must strictly follow all the rules:

Stop smoking.
Restrain yourself when sneezing and coughing, try not to do this, and also do not blow your nose intensely.
Avoid colds, as they will lead to serious complications.
Avoid solid, cold and hot foods during rehabilitation.
Do not visit a bathhouse or sauna, dive under water, or engage in any sports where there is a risk of injury.
Do not travel by air.

What materials are used?

In each of the variants of such plastic surgery, grafts are used. They can be:

Bone tissue of the patient, taken from any healthy part of the body. The rib and ilium are selected, but most often the outgrowths or tubercles of the upper jaw, as well as a small area of the chin, are used.
Allograft - taken from a donor who is another person. Although usually for these purposes they take cadaveric bone, which is further processed. Such a transplant takes longer and is more difficult to take root, but any risks are almost eliminated.
Xenograft – hard tissue of animal origin. This is a more affordable option, but healing may also take longer.
Alloplasts are artificial materials that can completely replace living tissue, take root well and rarely cause rejection. For these purposes, hydroxyapatite and any of its derivatives are used.

Video: about bone tissue building.

How much does the operation cost?

The price for such a complex procedure will largely depend on both the clinic itself and the chosen method of plastic surgery. In addition, the price may also include all the materials used, as well as the implantation procedure, if it is carried out simultaneously with a sinus lift, for example.

Based on the prices of Moscow private clinics, the average cost varies from 150 to 450 dollars for the operation itself. But you can also find various promotions, special offers and discounts. What is more important in this case is not the price, but the quality of the doctor’s work.

After the extraction and loss of teeth, a decrease in the bone mass of the jaw occurs due to the lack of chewing load. If the lost tooth root has not been replaced with an implant, the bone tissue begins to shrink. Therefore, in dentistry, bone tissue augmentation is performed - an operation to restore the required volume of bone mass. How is the operation performed, and in what cases are denture implantation contraindicated for patients?

The volume of bone mass does not always decrease after tooth extraction; sometimes the causes of jaw bone atrophy can be:

age-related changes;
injuries to teeth or jaw;
anatomical features of the jaw structure;
poorly made removable dentures;
genetic characteristics of the patient;
infectious diseases of the oral cavity.

With age, metabolic processes are disrupted, bones become loose, brittle, and calcium is actively washed out of them. All this leads to bone atrophy and requires correction.

Wearing removable dentures for a long time has a negative effect on the bone-jaw structures: dentures cannot provide a uniform chewing load on the jaw bones, which leads to atrophy.

Atrophy can be in genes and result from genetic predisposition. Abnormal skull structure is extremely rare.

The quality of bone tissue structure is also affected by infectious diseases of the oral cavity - periodontal pathologies, cysts, neoplasms, etc. This is due to the penetration of infection into the gum tissue and the formation of foci of purulent inflammation. A cyst forms near the root of a tooth, gradually destroying bone tissue. Advanced forms of periodontitis lead to the loss of healthy teeth due to pathological changes in the alveolar processes - connecting the root to the jaw bone.

Bone augmentation in the lower jaw is different from surgery to restore bone volume in the upper jaw. This is due to the peculiarity of the structure of the skull - the location of the maxillary sinuses. The length of the denture pin does not allow them to be firmly anchored in the jaw bone, and there is a risk of violating the integrity of the sinuses. Deformation of the maxillary sinus leads to tissue infection and the development of chronic sinusitis.

Consequences of bone atrophy

A decrease in bone mass not only leads to impaired chewing function, it has negative aesthetic and physiological consequences:

change in the shape of the face - sunken lips, sunken cheeks;
the appearance of wrinkles around and near the lips;
change in the quality of diction - lisp, unclear articulation;
changes in bite and related problems;
poor quality of chewing food, disruption of the gastrointestinal tract.

Contraindications to dental implantation

However, in some cases, implantation of dentures and the associated operation to restore the volume of bone structures has contraindications:

osteoporosis disease;
psychoneurological diseases;
acute inflammatory processes of the oral cavity;
chronic sinusitis and surgery on the maxillary sinuses;
nasal polyps and other neoplasms;
diseases of the circulatory system, poor blood clotting;
diseases of the immune system - HIV, AIDS.

Osteoplasty is contraindicated in the presence of a malignant tumor and in elderly patients. In many cases, heavy smokers are denied surgery - the implanted block is difficult to take root, and there is a risk of rupture of the surgical sutures and loss of the implant.

How does bone tissue build up?

Bone tissue growth during dental implantation takes place in several stages. The surgeon first examines the oral cavity and determines the required amount of work. The condition of the patient's jaw will be shown by an x-ray - where restoration of bone volume is required, and in what quantities. Substitute material is then selected.

Bone building material:

transplantation of a bone block from the lower jaw;
transplantation of bone chips from an animal - usually a bull;
synthetic material that stimulates tissue growth.

In the recent past, bone grafting from a recently deceased person has been practiced. However, this method is not always suitable, as is the replacement block of animal bone.

More often, extensions are made using synthetic fillers. This material is environmentally friendly, does not cause allergies, and takes root well. The only downside is the cost of synthetic fiber.

Algorithm of the surgeon’s actions:

local anesthesia or general anesthesia;
cutting the gums and filling the cavity with replacement material;
application of a protective membrane and suturing of the mucosa.

To reduce discomfort, surgical sutures for suturing gums are made of self-absorbing material, so there is no need to remove sutures. Extension by a dentist lasts from forty minutes to several hours.

When are dentures installed? In some cases, during (correction of the upper jaw), dental implants are installed. This is possible with a closed sinus lift; in the case of an open operation, the patient is fitted with dentures after the gums have completely healed - after six months.

Maxillary sinus lift

By what methods can bone mass implantation be installed in a patient? There are several options for this:

sinus lift for correction of the upper jaw;
directed tissue regeneration;
distraction osteogenesis;
autogenous block transplantation.

Sinus lifting can be performed in an open or closed manner. For minor atrophy, a closed method is used along with the installation of dental implants. In case of severe atrophy, an open operation is performed - with an incision in the gum and installation of a bone block of the required volume.

With an open sinus lift, temporary plastic teeth are installed, which are replaced with permanent ones after six months. The advantage of sinus lift over removable prosthetics is the complete restoration of chewing load with the cessation of atrophy. This distinguishes bone grafting from other prosthetic methods, which cannot prevent further atrophy.

Disadvantages of sinus lift may include the following complications:

chronic rhinitis/sinusitis in case of deformation of the maxillary sinuses;
the formation of foci of inflammation due to infection in the tissue;
complete rejection of the bone block, suture separation;
exposure of the protective membrane.

Complications after surgery may include fever, severe tissue swelling, and pain. After surgery, it is recommended to take painkillers, avoid overexerting your body and avoid bending forward. This is due to the risk of creating a pressure difference inside the skull, which can lead to rupture of the sutures and loss of the implanted implant.

After sinus lifting it is prohibited:

plan air travel within three months;
visit solariums, swimming pools, saunas and Russian baths;
drink liquids through a straw;
smoking and drinking alcohol;
do hard physical work.

Other methods of osteoplasty

Let's consider methods of bone block transplantation, guided tissue regeneration, distraction osteogenesis and restoration of gum contour.

NTR method

Directed tissue regeneration involves activating one's own tissues for growth. In this case, replacement biological tissue is implanted and isolated from the gums using a dental membrane. The protective film ensures the safety of the biomaterial from leaching and exposure to external factors. Gradually, bone mass is restored due to tissue regeneration.

The membrane can be made of absorbable material. The membrane made of non-absorbable material is removed after a certain period of time. The choice of material depends on the patient’s clinical case and is determined by the dental surgeon.

Replanting blocks

This method of surgery is performed using donor bone removed from the patient's palate, lower jaw or chin. The autograft takes root quickly and does not cause rejection. However, this method is only suitable for correcting the width of the bone, but does not solve the issue of height. Another disadvantage of direct transplantation is the impossibility of simultaneous installation of dentures: the block must first take root. In total, the patient is forced to undergo three surgical procedures: removal of donor material, implantation of a block, installation of implants.

Distraction osteogenesis

The distraction osteogenesis method involves expanding (increasing volume) the existing bone mass. The surgeon stretches the bone, and the resulting voids are filled with the patient’s own cells—the regenerate. The method is used in cases of abnormal jaw structure or after jaw injuries.

Mandibular plastic surgery

How is mandibular plastic surgery performed? The complexity of the method is the close location of the artery and the nerve responsible for the functioning of the jaw muscles. If the surgical procedure is unfavorable, there is a risk of loss of chewing function and numbness of the tongue. To displace the nerve, micro surgery is performed using 3D modeling, comparing the results with computed tomography data of the jaw.

Restoration of gum contour

Bone atrophy directly affects the reduction in the volume of gum tissue. As a result of this pathology, the roots of the teeth are exposed, which causes psychological and physiological discomfort to the patient. Exposed roots are not protected by an enamel coating and react with pain to thermal changes. From an aesthetic point of view, exposed crowns cause discomfort during communication. After restoration of bone volume, manipulations are performed to accelerate the regeneration of soft tissues.

Osteoplasty for periodontitis

Advanced periodontal disease leads to the loss of healthy teeth. Dentists use guided bone regeneration, which restores jaw height and prevents the development of jaw osteoporosis.

Benefits of osteoplasty

Many patients are afraid of a surgical solution to the problem of tooth loss and are content with removable dentures. However, they do not solve the issue of jawbone health, but provoke further development of atrophy. Firstly, removable dentures do not provide an even chewing load on the jaw. Secondly, due to a further decrease in bone mass, dentures require correction or replacement due to the discrepancy between the sizes of the new jaw shape.

Despite possible complications in the postoperative period, osteoplasty solves important issues of aesthetics and health:

complete restoration of chewing function;
restoration of the natural contour of the face;
possibility of installing dental implants;
preventing the development of local osteoporosis.

Bottom line

Osteoplasty is the only method of restoring the natural functions of the jaw without the risk of developing pathologies. To avoid surgery to replace a large volume of atrophied bone, it is necessary to immediately install an implant in place of the lost tooth. Six months after tooth root removal, the irreversible process of bone tissue atrophy begins.