What is bone plastic surgery and why is it necessary?

After the removal of the tooth, the bone tissue of the jaw stops performing its retaining function, so its resorption occurs (part of the bone tissue may also be lost due to the inflammatory processes that led to the removal of the tooth). And sometimes, when a patient comes to the Sirius-Dent clinic for prosthetics, it turns out that the available bone tissue is not enough for a dental implant. In such cases, the surgeon offers bone tissue augmentation, but our patients do not have to wait another 9 months for implant placement – we perform both procedures in one step.

What is sinus lifting?

Sinus lift (sinus lifting) is one of the options for increasing bone tissue on the upper jaw. It can be open or closed, depending on how many millimeters of bone tissue the patient is missing.

If the volume of the bone tissue of the teeth is significantly smaller than the 8 mm required for implant installation — for example, 1-5 mm, we perform an open sinus lift. This is a rather complex operation, during which the surgeon creates a small window in the bone so as not to damage the lining of the maxillary sinus, peels off the lining from the bone, lifts it, and inserts bone-substitute material into the formed “pocket”. It primarily performs a framework function, that is, it holds the volume inside which new bone tissue is formed. As part of cooperation with the VIRTUS Institute, we began to involve cell technologies and plant the patient’s stem cells in the bone tissue substitute, which optimizes the process of bone tissue formation. In this way, what is lost after tooth extraction is compensated for, and at the same time, sufficient bone volume is built up to accommodate the implant.

But it is not always necessary to open the maxillary sinus if the patient lacks 1-2 mm to the required 8. For such cases, there is a closed sinus lift – a special surgical technique that helps raise the floor of the maxillary sinus up to 2.5 mm and safely install the implant without perforation (damage to the shell of the maxillary cavity).

Why is it necessary to build bone before dental implants?

A certain amount of bone tissue in terms of height and width is required to install an implant, and later to carry out prosthetics with a crown. If the doctor dares to implant a tooth, knowing that the bone volume is not sufficient, it will lead to catastrophic consequences for the patient. So, when it comes to the upper jaw, the implant will break through the shell of the maxillary cavity, which will not only result in disintegration and the impossibility of further prosthetics, but will also cause odontogenic sinusitis — and such a person will need a joint operation by an ENT surgeon and a maxillofacial surgeon. In the worst case, the implant will disintegrate and fall into the maxillary cavity (in my practice, there was even a case when during surgery we took out a patient’s maxillary cavity… a gum former. How it could get there is still a mystery). During the installation of an implant in the lower jaw with a lack of bone volume, there will be not only a high probability of disintegration, but also a significant risk of damage to the vascular-nerve bundle that innervates the lower part of the face.

Because of these risks, some surgeons prefer to offer patients alternative, non-standard-shaped implants that can be tried in a smaller amount of bone (or a narrow jawbone), but with no certainty that they will take root. The regenerative properties of our body are sometimes really impressive, but unusual implants often do not work.

At the Sirius-Dent clinic, we do not risk the health of our patients, but perform bone plastic to obtain the necessary volume of tissue that guarantees the implantation of a standard implant.

Causes of lack of bone tissue

When we remove teeth, the bone tissue no longer has anything to hold it in, and therefore begins to dissolve unnecessarily. On the upper jaw, this leads to the fact that the maxillary sinus, which is located between the eye and the upper teeth, increases in depth and volume, and on the side of the oral cavity, the alveolar bone rises up. On the lower jaw, as the bone resorbs, the neurovascular bundle is closer to the surface, which can also cause a number of problems later. Externally, the long-term absence of teeth is manifested by the fact that the lips and cheeks sink, forming the so-called “aging profile” – in order to prevent this, you should not wait a long time with prosthetics. Or at least install a removable prosthesis that will perform the function of supporting the lower half of the face until full implantation.

In which cases is bone grafting necessary, and in which cases is it not?

Bone grafting is necessary for those patients who, after losing teeth, are planning a dental implant, but do not have enough volume due to bone tissue atrophy. Traditionally, the surgeon carries out bone plastic surgery (sinus lift or another option of directed tissue regeneration, according to the indications) 9 months before the installation of the implant and subsequent (about 6 months) prosthetics with a permanent crown. But we offer a different approach, when two stages of tooth implantation are done simultaneously. Yes, a sinus lift can be combined with implantation, and then the bone tissue will already grow around the implant, and we will install the crown 9 months after the operation. Or, if there is no need for osteoplasty, because there is enough bone tissue, we install an implant with a greater load and can immediately put on a temporary crown removed from the bite, and then the patient will leave the clinic not with a gum former, but with a tooth.

There is also no need for a sinus lift if you choose the option of installing a bridge prosthesis, when several crowns are connected together and attached to adjacent teeth.

How is bone plastic done?

Bone plasty is also the treatment of teeth in a dream, because it is a complex and painstaking operation, during which it is necessary to carry out manipulations in the maxillary cavity without damaging its membrane – at the same time, every careless movement of the doctor or patient can be fatal and cause perforation. We know what to do in such a situation to prevent further complications, but it is better to minimize the risks. In addition, we are usually talking about distant teeth, which are difficult to reach, so when the patient is under anesthesia, it adds convenience and the possibility for the surgeon to work with supports.

Therefore, preparation for bone plastic surgery includes:

• consultation of a maxillofacial surgeon, who will offer the best option for bone augmentation and tell in detail about the future operation;
• computer tomography and other necessary analyses;
• consultation of an anesthesiologist.

Despite our extensive experience in osteoplasty, we are constantly looking for ways to improve it. In particular, we actively cooperate with the SmartCell cell laboratory of the VIRTUS Institute, which helps us with regenerative technologies.

With the help of a special program, we model those fragments of bone tissue that the patient lacks, and on top of them – a titanium mesh. We print it on a 3D printer and install it on the alveolar process of the jaw during surgery. Thus, the mesh reproduces the volume that the doctor modeled in the program, and between it and the jaw bone, we insert bone-substitute material.

And here comes the turn of the VIRTUS Institute’s contribution — they have already taken the patient’s blood, grown stem cells and transplanted them onto our bone substitute material in a nutrient medium. Therefore, a person receives enough biological material to restore the bone faster and better. Such involvement of the latest regenerative technologies will certainly be a step forward in maxillofacial surgery.

If the patient has his own donor material, we can also increase the bone volume under the implant by transplanting a bone block.

Complications after regeneration of bone tissue

Rehabilitation after osteoplasty is usually painless. During the first 2-3 days, the patient may feel discomfort in the suture area, moderate swelling of the cheek and a slight increase in temperature, but this passes on the 5th day at most. A week or 10 days after bone plastic surgery, the surgeon removes the stitches.

What is done after bone augmentation?

We usually perform bone augmentation (whether sinus lift or bone block transplantation) in one step with implant placement, so bone restoration and implant integration take place at the same time. 6-9 months after the operation, you can proceed to the stage of prosthetics, when a permanent crown is installed and inserted into the bite instead of the former that provides gum plastic.