Increasing the lost volume of bone tissue. Bone grafting

Go directly to:

Implantation in dentistry is the most modern method of prosthetics, and if a tooth has been removed recently, it does not cause almost any difficulties and does not require additional costs and 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 classical root-shaped implants becomes impossible. In this situation, bone augmentation becomes the most rational solution.

Bone augmentation during dental implants

Bone grafting surgery consists in supplementing the existing bone with a material that stimulates its growth. In various cases, the 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 will force normal vessels and nerve endings to grow through the bone tissue. After that, the new bone is strengthened and is ready to accept the chewing load, which in an adult is from 50 to 300 kg.

Bone tissue augmentation for implantation in the upper and lower jaws have their 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 increasing bone tissue in the lower jaw lies in the close location of the mandibular canal in which a large nerve, artery and vein passes. If the height of the bone above the inferior alveolar nerve is less than 10 mm, it is more likely to be damaged by 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, the technique of autograft transplantation is often used, in which the 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 chips with hydroxyapatite, covered with a collagen film. After 5-6 months, the screws are removed and the possibility of implant placement is assessed.

Important! In our Center, this technology is not used due to the transition to BMP technology (non-traumatic, controlled stimulation of the growth of one's own bone without fragment grafting).

Bone augmentation of the upper jaw

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

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 sleep is not anesthesia with all its inconveniences, but a modern safe technology for the comfortable conduct of modern high-tech operations. The average duration is 40 minutes, then you can safely drive home in your own car.

Complications and risks

Unprofessional management and non-compliance with the protocol of bone augmentation surgery leads to various troubles, among which the undoubted hits are infection, which can lead to membrane rupture, 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 methodology of the procedure, the experience and attentiveness of the doctor reduce the probable complications to zero. Reduces risk and 3D design on a virtual model.

Sometimes patients consider normal postoperative conditions, such as mild pain, swelling, or moderate bleeding, to be postoperative complications. If the swelling and other symptoms after surgery disappear after three days and the bleeding is not too heavy, there is nothing to worry about. If pain and swelling persist, you should immediately consult a doctor.

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

our team

In case of refusal to build up bone tissue, the following risks appear:

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

Bone augmentation in periodontitis

With inflammation of the periodontal tissues, the loss of bone tissue threatens with tooth loss. One of the methods in the course of complex treatment of the disease is the methods of directed regeneration. They allow you to restore the lost height of the bone and permanently prevent the occurrence of local osteoporosis.

Preparations for increasing bone tissue

Different materials are used as preparations. Previously, it was believed that own tissues taken from another part of the jaw take root best, however, taking one's own bone material is another operation, and quite traumatic.

Our Center uses natural preparations and BMP technologies that do not require the collection of the patient's own tissues. These are growth stimulants, thanks to which one's own bone is naturally predictably restored to the desired size. After that, you can install a root 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 give a lifetime guarantee for implantation.

Patient reviews

A patient

I want to thank Ostankovich Victoria Mikhailovna! Doctor from God! She did a great job with my teeth. I got very lucky with her. Victoria Mikhailovna reassured me and did everything possible so that I no longer had complexes. Excellent specialist! Thank her very much!

Section "Implantation of teeth" on the website

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

But at the current level of modern dentistry, this should not be very upsetting. After all, there are implantation methods that are possible even with a lack of bone tissue without its preliminary build-up. For this, such types of implantation are used as:

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

The course of implantation consists in the fact that an arc-shaped bracket is installed on the lower edge of the body of the lower jaw by an extraoral surgical method. Two implant-pins are introduced through the bone, with their further use for fixing removable dentures.

submucosal implantation are mainly used to stabilize full or partial dentures. It consists in the installation of intramucosal implants, which allow you to do without the introduction of a prosthesis into the bone tissue.

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

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

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

The installation of mini implants does not require the presence of dense bone tissue, a wide and high alveolar ridge.

The installation of mini implants is carried out within a few minutes using a minimally invasive surgical technique.

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

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 openwork, 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 the implants are installed in 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 proceed faster and more efficiently.

It is usually used to lengthen and strengthen the root of the tooth, which gives additional stability to the entire structure.

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

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

In this case, an arcuate bracket is placed on the lower jaw. After that, two through implants in the form of pins are installed. Implants protrude into the oral cavity, due to which removable dentures are fixed on 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 the extraction of teeth, the bone tissue undergoes gradual atrophy, which leads to a decrease in the width and height of the bone in the place of the 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 growth during dental implantation Implantologists' reviews suggest that it is necessary not only for the normal functioning of the implant (in terms of 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 result of this, gum recession and implant neck exposure occur.

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 very well - 2.5 mm. If the front surface of the implant is covered by a bone less than 2 mm thick, then this means 100% bone resorption around the implant neck, accompanied by a lowering of the gum level and exposure of the implant neck. In this case, the implant will still carry a functional load, however, if it stands in the smile zone, the gum contour around the implant will eventually become aesthetically unacceptable.

2) Secondly- the thickness of the bone wall between the implant and the root of the adjacent tooth should ideally be 3 mm, tolerable - 2.5 mm. If this distance is smaller (for example, 1.5-2.0 mm), then the following problem arises. Around the neck of the implant, even in normal conditions, there is always a slight resorption of the bone. If the bone septum between the implant and the tooth root is too small, then bone resorption will also occur at the root surface adjacent to the implant. This means a lowering of the gingival level and the absence of an interproximal gingival papilla (i.e. poor esthetics).

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

Causes of bone deficiency

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

2) The second reason is traumatic dental surgeons. Usually, during the removal, the surgeon absolutely does not think about the safety of the bone walls of the alveoli around the tooth, biting them with forceps. If you are planning an extraction with subsequent implantation of a tooth, then it is best to carry out such an extraction with 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 there is a decrease in the width of the alveolar process,
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 implants: reviews

There are many different methods of bone grafting, but they can be conditionally 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 ridge of the alveolar process.

Most commonly used techniques –

splitting of the alveolar process,
bone block transplantation,
Guided Bone Regeneration (GBR)
sinus lifting method (used with a lack of bone height in the lateral sections of the upper jaw).

All these operations are performed under local anesthesia, if necessary (the fear of the patient) 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 techniques have their pros and cons… Histological studies have shown that after bone augmentation by 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 implanted bone material.

1. Splitting of the alveolar process -

Used for horizontal bone resorption to increase the thickness of the alveolar process. It can be performed both on the lower and on the upper jaw. It must be said that this is the most effective method of expanding the alveolar process today, which, moreover, 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 you to simultaneously carry out both expansion and installation of implants.

The content of the "Split-Control" methodology(Fig.5-10) –
after detachment of the mucoperiosteal flaps (gums), a cut is made in the center of the crest of the alveolar process with a cutter or other special instruments to the height of the future implant (Fig. 6). Next, a hole for the implant(s) is marked with a pilot drill, and spreaders are screwed into the prepared holes (Fig. 7). 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 on the sides of the implant, which is filled with bone material, which, if necessary, can be applied in excess and outside the alveolar process, covering it all with a special resorbable membrane (Fig. 9). After that, the wound is sutured, and we wait for the osseointegration of the implant within 3-4 months.

Bone grafting of the lower jaw (splitting method) –

Advantages of the technique –

Firstly- due to the splitting of the ridge, we get a bone defect that has bone walls on all sides (except on top). Thanks to this, fast and high-quality osteogenesis (the formation of a new bone) occurs, because spongy bone in the depths of the alveolar process is rich in blood vessels, osteoblasts, mesenchymal cells, growth factors ...
By the way, why it is much worse to increase the width of the bone not due to splitting (from inside the alveolar process), but to do this due to the external attachment of bone blocks or bone chips outside the cortical plasty of the alveolar process. The fact is that the outer cortical layer of the bone is very dense and there are practically no vessels in it. Accordingly, the transplanted bone material will take a very long time to grow into vessels, bone formation will proceed more slowly, 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, for example, bone material "Osteodent-K" and the membrane "Osteodent-Barrier".

Thirdly– installation of implants with this technique in most cases is possible immediately. If the implants are installed later, then only 3-4 months will have to pass between the operations, which is much 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 methods. With “Split-Control”, only a cut is made 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 the complete detachment of the bone block (vestibular cortical plate).

Then this block is fixed with screws, which often break it. Implants with this modification of the technique are not installed immediately, but after 3-4 months. In addition, it is very traumatic and more risk of complications. This type of technique should only be used on 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 parts of the jaws). Block sampling can be carried out in the region of the tubercle or zygomatic-alveolar ridge of the upper jaw, or in the region of the branch or chin area of the lower jaw. Less commonly used are bone blocks of allogeneic origin (from another person), as well as xenogenic origin (bovine bone), which is associated with their much lower efficiency.

An example of a bone block transplant operation –
On 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 chips, after which the blocks and the surrounding bone tissue must be closed with a collagen membrane (exactly the same as those used for guided bone regeneration). The membrane is fixed to the bone with the help of special metal pins (Fig. 14), and then the mucous membrane over the operation site is tightly sutured.

Bone block transplantation: animation and video of the operation

Advantages of this method –
this is an excellent method for increasing bone volume with predictable results. The gold standard for this method is the use of an allograft (a bone block taken from the patient himself). Moreover, it is very important that the transplanted graft be "cortical-spongy", i.e. had not only a cortical plate, but also spongy bone tissue. In this case, a predictable and positive result of bone block transplantation can be obtained.

Cons of this method –

An additional operation to take the bone block is required.

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 a longer engraftment, i.e. after such an operation, it will be necessary to wait about 6-8 months before starting the installation of implants at all. This is due to the fact that the bone block is screwed on the outside of the jaw. The superficial cortical layer of the jaw bone has very few vessels, and therefore the germination of vessels into the transplanted bone block is very slow.

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

3. Guided tissue regeneration (GTR) -

This method can also be used to increase the width of the alveolar process, as well as 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.

Guided tissue regeneration (synonymous with guided 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 adverse factors.

Guided bone regeneration: examples of operations

1) Clinical case No. 1 –
Photo 17 (in the area of the 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 bone grafting, you can see the installation of the implant in this area…

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

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

There are different types of membranes, resorbable (Bio-Gaid), non-resorbable (Gore-tex or mesh titanium 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 titanium-reinforced membranes. All these membranes are expensive, but the use of cheap membranes (such as Osteoplast) is not suitable for this technique.

Choice 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 –
an 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 minus here - the need for an additional small intervention for the collection of bone material.

Combination autograft + xenograft –
in a ratio of 1:1, bone chips (taken from the patient himself) are mixed with xenogenic material, i.e. based on bovine bone. Such a high-quality and effective material as "Bio-Oss" can serve as an example of it. 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 the cadaveric material (of other people). These materials are purchased from a special tissue bank, all materials are carefully processed and 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 growth will be lower.

Guided bone regeneration with immediate implantation: operation video

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

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

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

Bone augmentation during dental implantation: price 2019

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

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

This happens when a person has thought too long about whether to install implants. During the absence of dental units, the hard tissue atrophies too quickly, which leads to the need for bone grafting.

About the lack of bone tissue in a patient

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

If the patient needs to implant an implant in order 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, at least 10 mm of a solid base is needed.

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

A very important point is that in order to avoid any unpleasant complications, you should choose a good clinic, an experienced doctor and follow absolutely all the rules for preparing 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 a sufficiently reliable fixation of the implant, if the bone is shorter than the artificial rod.
To prevent the displacement of teeth, their loosening, loss and other pathologies of the dentition.
Prevent distortion of facial expressions and articulation.
Restore chewing function, which will inevitably occur with atrophy.
Prevent facial contours from being distorted due to jaw reduction.

Doctors highlight the following advantages of the process when artificial bone material is added or augmented in another way:

Complete restoration of all jaw functions, even if atrophy has reached a large volume.
Makes affordable high-quality implantation, in which the rods will hold for a long time and reliably.
The attractive appearance of the gums returns, and after prosthetics, the entire dentition.
Following the rehabilitation period, there is a complete disappearance of all the inconveniences that accompanied tooth loss and bone atrophy.

True, there are some disadvantages of the procedure, such as a long recovery stage, the process of the operation 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 the expected result be achieved.

A photo

Bone augmentation options for dental implants

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 NTR. In the process of NTR, 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 resorbable. 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 transplanting a bone block, most often a piece of the patient's own bone is used. Usually it is taken from the chin. It turns out two wounds, which is considered a disadvantage of the procedure. But such a transplant takes root better and rejections do not happen with it. This bone is screwed with special screws to the right place, compacted with chips or granules and sutured with a membrane. It is she who will not allow them to be washed out and will contribute to rapid regeneration. Another disadvantage of bone block implantation is the duration and the procedure several times. After all, initially they make two injuries, and then they also perform an additional operation to remove the membrane and implant the pin.

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

Mandatory health examination, setting the degree of atrophy using x-rays. Taking blood samples with extended interpretation. After all, the operation should be carried out only in the absence of any contraindications.
Anesthesia. Most often, local anesthesia is chosen, but in rare cases of increased sensitivity or susceptibility of the patient, the doctor may choose a light general anesthesia.
An incision is made in the periosteal flap, which exposes the rest of the natural bone. In this case, the doctor can additionally diagnose the condition and size of atrophy. Accordingly, the desired material for building up and its adequate amount are selected.
Then the procedure itself takes place, which will differ depending on the chosen method of plastic surgery.
After all the manipulations, the doctor is obliged to sew up the bone with the installed components and secure the wound. For this procedure, absorbable sutures are most often used, so removing the sutures will be unnecessary.

After the operation, the dentist will definitely advise on what can and cannot be done. It is very important to adhere to these recommendations so that there are no consequences.

If the operation was successful, the rehabilitation period will last up to a month. The first week is also necessary to drink painkillers and anti-inflammatory drugs.

Sinus lift

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

In this case, a mechanical lifting of the maxillary sinus is performed so that the necessary tissue can be built up under 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 a sinus lift are:

The 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 make sure that the patient does not have the following problems:

The presence of several partitions in the sinuses themselves.
Polyps in the corresponding zone.
Constant runny nose for various reasons.
Sinusitis in any form.
Broken or weak bone.
Previous surgical interventions in .
Bad habits in the patient in the form of frequent smoking.

Open

An open sinus lift is a complex operation that is done only in extreme cases. Carry out the following manipulations:

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

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

Closed

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

Initially, the bone bed is prepared, where the rod for the implant will be installed. Its size should not reach the maxillary sinus by 1-2 mm.
With the help of a special tool and light tapping, the doctor moves the desired fragment inward, thereby raising the mucosa to the required height.
The osteoplastic material is introduced through the created hole and at the same time the implant shaft is installed.

While the tissues are healing and the gum is forming, the patient may be offered to use plastic temporary structures that mimic the dentition for that period until permanent implants are created and installed.

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

Damage to the sinus, leading to a chronic runny nose.
Possible sinking of the entire structure deep into, followed by its forced removal.
The occurrence of inflammation in the maxillary region, which will have to be cured and only after that to perform a second implantation procedure.

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

Give up smoking.
Restrain when sneezing and coughing, try not to do this, and also do not blow your nose intensively.
Avoid colds, as they will lead to serious complications.
Refuse for the period of rehabilitation from solid, cold and hot food.
Do not go to the bathhouse or sauna, dive under water or engage in any sports where there is a possibility of injury.
Do not travel by air.

What materials are used?

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

The patient's bone tissue taken from any healthy part of the body. They choose the rib, the ilium, but most often they use outgrowths or tubercles of the upper jaw, as well as a small area of \u200b\u200bthe chin.
Allograft - taken from a donor, which is another person. Although usually for these purposes they take a cadaveric bone, which is additionally processed. Such a transplant takes longer and 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 can also be delayed.
Alloplasts are artificial materials that can completely replace living tissue, while taking root well and rarely cause rejection. For these purposes, hydroxyapatite and any of its derivatives are used.

Video: about bone growth.

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 cost may also include all the materials used, as well as the implantation procedure, if it is carried out simultaneously with the sinus lift, for example.

Focusing 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. More important in this case is not the price, but the quality of the doctor's work.

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

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

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

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

Long-term wearing of removable dentures negatively affects the bone and jaw structures: dentures cannot provide a uniform chewing load on the jaw bones, which leads to atrophy.

Atrophy can be laid down in the genes and be the result of a genetic predisposition. The abnormal structure of the skull is extremely rare.

The quality of the structure of bone tissue is also affected by infectious diseases of the oral cavity - periodontal pathologies, cysts, neoplasms,. 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 the tooth, gradually destroying the 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 bone volume restoration surgery 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 prosthesis pin does not allow them to be firmly fixed in the jaw bone, 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

The decrease in bone mass leads not only to a violation of the 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 the lips and next to them;
change in the quality of diction - lisp, fuzzy articulation;
change in bite and related problems;
poor-quality chewing of food, disruption of the digestive tract.

Contraindications for dental implants

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

osteoporosis disease;
psychoneurological diseases;
acute inflammatory processes of the oral cavity;
chronic sinusitis and operations on the maxillary sinuses;
polyps in the nose 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 the operation - the implanted block is difficult to take root, there is a risk of rupture of the surgical sutures and the implant falling out.

How does bone growth happen?

Bone augmentation during dental implantation takes place in several stages. Previously, the surgeon 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 the restoration of bone volume is required, and in what quantities. The replacement material is then selected.

Material for bone mass building:

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

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

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

The algorithm of the surgeon's actions:

local anesthesia or general anesthesia;
gum incision and cavity filling with replacement material;
imposition of a protective membrane and suturing of the mucosa.

For less discomfort, gingival sutures are made from a bioabsorbable material, so the sutures do not need to be removed. The build-up by the dentist lasts from forty minutes to several hours.

When are dentures fitted? In some cases, with (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 prostheses after the gums have completely healed - after six months.

Sinus lift of the upper jaw

What methods can be used to install bone mass implantation in a patient? For this, several options are used:

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

Sinus lift can be performed in an open and closed way. With a slight atrophy, a closed method is used along with the installation of dental implants. With severe atrophy, an open-type operation is performed - with a gum incision and the 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 six months later. The advantage of sinus lifting over the method of removable prosthetics is the complete restoration of the masticatory load with the cessation of atrophy. This distinguishes bone grafting from other methods of prosthetics, which cannot prevent further atrophy.

The disadvantages of a sinus lift can be 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, divergence of sutures;
exposure of the protective membrane.

A complication after surgery may be fever, severe tissue swelling, pain. After the operation, it is recommended to take painkillers, not to overload the body with excessive physical activity and not to lean forward. This is due to the risk of creating a pressure drop inside the skull, which can lead to rupture of the sutures and loss of the implanted implant.

After a sinus lift, it is prohibited:

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

Other methods of osteoplasty

Consider the methods of bone block transplantation, guided tissue regeneration, distraction osteogenesis and restoration of the gingival contour.

NTR method

Guided tissue regeneration involves the activation of one's own tissues for growth. In this case, a replacement biotissue 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 may be made of absorbable material. The membrane of non-absorbable material is removed after a certain period of time. The choice of material depends on the clinical case of the patient and is determined by the dental surgeon.

Block transplant

This method of operation is performed using a donor bone taken from the patient's palate, lower jaw or chin. The autograft takes root quickly, does not cause rejection. However, this method is only suitable for correcting the width of the bone, but does not solve the issue with the 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 endure three surgical procedures: removal of donor material, implantation of the block, and installation of implants.

Distraction osteogenesis

The method of distraction osteogenesis involves the expansion (increase in volume) of the already existing bone mass. The surgeon stretches the bone, and the resulting voids are filled with their own cells - the regenerate. The method is used in case of an abnormal structure of the jaw or after injuries of the jaw.

Plastic surgery of the lower jaw

How is rhinoplasty performed? The complexity of the method is the close location of the artery and the nerve responsible for the work of the jaw muscles. With an unfavorable course of surgical intervention, there is a risk of loss of chewing function and numbness of the tongue. To displace the nerve, a micro operation is performed using 3D modeling, comparing the results with data from computed tomography of the jaw.

Gingival contour restoration

Atrophy of bone tissue directly affects the decrease 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. Bare roots are not protected by an enamel coating and react with pain to thermal changes. From the point of view of aesthetics, bare crowns cause inconvenience during communication. After restoration of the bone volume, manipulations are carried out 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 the height of the jaw and prevents the development of jaw osteoporosis.

Benefits of osteoplasty

Many patients are afraid of a surgical solution to the issue of losing teeth and are content with removable dentures. However, they do not solve the issue with the health of the jawbone, but provoke the further development of atrophy. Firstly, removable dentures do not provide a uniform chewing load on the jaw. Secondly, due to the further decrease in bone mass, prostheses require correction or replacement due to a mismatch in size with the new jaw shape.

Despite the 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;
the possibility of installing dental implants;
prevention of development of local osteoporosis.

Outcome

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 amount of atrophied bone, it is necessary to immediately install an implant instead of a lost tooth. Six months after the removal of the tooth root, an irreversible process of bone tissue atrophy begins.