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Bone Grafting & Guided Bone Regeneration

Today, more than ever, advances in medicine and dentistry have led to new and expanded areas of treatment. Two such areas, bone grafting and guided bone regeneration (GBR) in the jaw bones and around teeth, have recently experienced tremendous growth. Procedures to repair and grow new bone, unheard of just a few years ago, are now part of routine dental surgical care. This page will help you better understand what bone grafting and GBR are, what options are available to you and what benefits you may gain from these procedures.

What are bone grafting & GBR?

Bone grafting is a surgical procedure that replaces missing bone with a material called a bone graft. This material not only replaces missing bone, but also helps your body regrow lost bone. This new bone growth strengthens the grafted area by forming a bridge between your existing bone and the graft. Over time the newly formed bone with replace much of the grafted material. GBR is a procedure in which a membrane is placed over the bone graft site. This membrane further encourages new bone to grow and also prevents the growth of scar tissue into the grafted site.

Why are bone grafts & GBR needed?

Bone grafts & GBR are needed when a part of your body is missing bone. This missing portion of bone is frequently called a "bony defect". Examples of jaw bone defects are: defects surrounding roots of teeth (periodontal defects); defects which occur following tooth extraction; generalized decrease in quantity of jaw bone from trauma or long-term tooth loss; defects surrounding dental implants; defects resulting from cyst or tumor surgery.

How are bone grafting & GBR procedures performed?

The following is one example of these procedures following tooth extraction.

1. The tooth is removed and the remaining tooth socket is thoroughly cleaned of all inflamed and infected tissue.

2. An appropriate bone grafting material is carefully placed into the extraction socket.

3. GBR membrane is often placed over the grafted material.

4. Sutures placed into the gum tissue allow proper healing of the surrounding soft tissues.

Are bone grafting & GBR painful procedures?

These procedures are usually done in the doctor's office under local anesthesia or local anesthesia with I.V. sedation or occassionally general anesthesia. The procedures themselves are without pain. Post-operatively, there will be some swelling and some mild to moderate discomfort, especially from other procedures performed, such as tooth extraction, cyst removal, etc. Your doctor will prescribe an oral analgesic to help relieve your discomfort. If a more invasive second procedure is required to obtain bone (i.e. from your hip, chin area, etc.) then your post-operative discomfort will be increased but still manageable.

What special care is required after my grafting procedure?

Generally, the same prudent care required after any dental surgical procedure will be sufficient following jaw bone grafting & GBR. The area must be kept clean, often with the help of a prescribed mouth rinse. An antibiotic, if prescribed by your doctor, must be taken. Antibiotics, however, are not always required. Undue pressure over the grafted site must be avoided until new bone is well on its way to being formed. This means that previous dental prostheses, such as a removable full or partial denture, must be altered by your dentist following the grafting procedure. And finally, brush and floss your teeth as you normally do. However, avoid the gum tissues surrounding the bone graft until they are well healed (usually about six weeks).

How successful are bone grafting & GBR?

Recent advances in technology have dramatically increased the success of these procedures, leading to bone formation and resolution of the defect. However, depending upon the reason needed for these procedures, success rates will vary. Also, different graft & GBR materials seem to affect the amount of new bone formed. And finally, your own overall health will also help determine the degree to which new bone will form within the grafted site.

Are there different types of bone grafts & GBR membranes?

Yes. Some grafts are taken from different parts of the patient's own body (i.e. from the hip bone or chin). Other grafts come from deceased human organ donors, from synthetic materials, and from highly purified bone mineral. Likewise, there are different types of GBR membranes. Some are made from synthetic polymers and must be removed during a second surgery several weeks or months later. Others are made from natural materials and are gradually resorbed (melt away) by the body.

What type of grafts are used at your office?

We use Bio-Oss which is a safe, effective bone grafting material from specialty processed bovine sources. Under the electron microscope, Bio-Oss looks very similar to human bone. Because of its similarity to human bone, Bio-Oss is highly successful in helping new bone to form. In many cases, using Bio-Oss eliminates the need for additional surgery to obtain your own bone as grafting material.

How does Bio-Oss work?

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

Is Bio-Oss safe?

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

How long does it take for new bone to form around the Bio-Oss graft?

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

What type of GBR membranes are used at your office?

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

How is Bio-Gide different from other membranes?

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

Is Bio-Gide safe?

Bio-Gide, like many artificial membranes, is composed of porcine delivered collagen. Using special processing and sterilization procedures, Bio-Gide is made completely biocompatible and sterile. Every batch of Bio-Gide membranes undergoes a series of tests confirming its purity and sterility, assuring total safety of the materials. Bio-Gide is not indicated for patients with a known history or allergic response to collagen or porcine derived products.

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