Special surgical interventions in implantology – Bone Addition in Dentistry

Surgical procedure to thicken, widen and volumetrically enlarge the mandibular or maxillary bone. This procedure is necessary when the bone mass is so thinned that it no longer allows the insertion of dental implants.

Following tooth extraction, bone resorption always occurs in the alveolar process.

After a tooth extraction, about 25% of the original bone volume in which the tooth is located is lost in the first year.

The bone then continues to reabsorb more slowly, so that three years after extraction, the bone has reabsorbed about 40%-60% of its original volume.

Five years after extraction, a bone that was initially 8 mm thick may be less than 3 mm thick.

For these reasons, bone addition surgery is often required, especially when an area of the jaw structures with high physiognomic impact is affected.

Bone augmentation is necessary when an implant is to be inserted in a region of high chewing demand.

By increasing the bone volume, an implant with a larger diameter and length can be inserted, thus ensuring better stability of the dental implant, allowing it to better take up the masticatory stresses.

Bone addition surgery can be performed in the same session with the insertion of dental implants, or it can be performed as a separate procedure, depending on the extent of the bone deficiency.

During bone augmentation surgery the patient will not feel pain. Although the bone addition operation is a complex operation, the patient will feel it as a routine dental operation, as it is performed under local anesthesia and after the operation, the patient is given painkillers, and the discomfort caused is minimal.

The materials used for bone augmentation are:

  • autogenous bone (harvested from the patient undergoing the procedure),
  • bone substitute harvested from animals, treated
  • resorbable membrane
  • calcium phosphate products and others.

Autogenous bone

It is harvested from the patient in regions of the oral cavity and is inserted into the area where the bone defect is to be restored, with very good results.

However, this method has the disadvantage that when the bone is harvested, another incision has to be made, which means extra surgery for the patient.

Animal bone substitute

The most commonly used is bovine bone, treated and sterilized so that there is no rejection or infection.

Although it is believed that in bone addition operations the patient’s added bone becomes the patient’s own bone, this idea is often false.

In general, following bone augmentation operations, autogenous bone is stimulated to regenerate, the artificial bone added merely provides a support on which the patient’s own bone cells will settle.

Following bone addition surgery, as the autogenous bone grows in size, the artificial bone is metabolized and re-softened.

Sinus lift surgery

Oral rehabilitation of patients with implants is very difficult when missing teeth affect the posterior area of the upper jaw.

After tooth extraction, bone resorption is often accompanied by an increase in the size of the maxillary sinus, so that insertion of implants in this area without bone addition would be difficult and there would be a danger of inserting implants into the maxillary sinus.

The procedure to increase the volume of bone in this area is called a sinus lift, in which the maxillary sinus is “lifted”, hence the name “sinus lift”, with the lower portion of the sinus then becoming bone.

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