Before dental implants can be placed, the jaw needs to have enough bone, good soft tissue, and enough space. When these criteria are unable to be met, our surgeons have many other techniques—including bone grafting and soft tissue grafting—to improve opportunities for success. With bone grafting, the goal is to provide adequate bone height and width for implant placement. With soft tissue grafting, the goal is to augment thin soft tissue, or to introduce tougher soft tissue when it’s lacking. Listed here are some of the most common bone and soft tissue surgery related procedures managed by the highly trained, diverse group of specialists at HNSA.
Banked (Allogeneic Bone)
When there is not enough bone for implant placement, or when a tooth is extracted and an implant is planned for the future, our surgeons can use bone-grafting techniques to augment the deficiency or preserve the existing bone dimensions. The most common form of bone graft material is pre-processed and banked bone graft material. When using banked bone, our surgeons use allograft (bone from human donors).
Harvested Bone (Autogenous Bone)
Harvested bone is bone harvested from the patient at another surgical site. This form of bone graft has the advantage of having all three of the ideal components (calcium scaffold, growth factors, and osteoprogenitor cells). However, it also requires a second surgery site.
Ramus and Chin Donor Sites
When using harvested bone, ramus and chin are commonly used. One of the advantages of these harvest sites is that they are located within the mouth, leaving no external scars. However, the amount and quality of the bone is limited.
Iliac Crest Donor Site
The hipbone is an excellent source of a large amount of high quality bone. However, the surgical site is distant and leaves a small external scar along the hip line. Following surgery, there is also a moderate amount of pain and a brief period (1-2 weeks) of walking with a cane and limping.
Tibia Donor Site
The shin is a great source of primarily cancellous bone. The incision is quite small, and there is a moderate amount of postoperative pain and walking with a cane (about 1 week).
Gingival/Connective Tissue Grafting
When the tough gum tissue (keratinized gingiva) wrapped around your teeth is thin, there is a risk of recession around implants. In order to prevent the boundary between the implant and crown from becoming visible, we can perform a connective tissue graft to augment the gum’s thickness. This tissue can be harvested from the palate or there are also xenograft (made from porcine collagen) substitutes.
Vestibuloplasty
The vestibule is the space between your lip and your gums and serves as an important avenue for food and drink to flow while eating. It’s also necessary for dentures to seat and seal well. For long-time denture wearers, atrophy and loss of bone height can result in poorly fitting dentures because the vestibule often becomes shallow. A vestibuloplasty can increase the depth of the ‘valley’ of the vestibule, allowing for a better denture fit.
Removal of Tori
Many patients have bony outgrowths in their upper or lower jaws—called tori. For patients without teeth, these can impede denture fitting. We can remove these outgrowths, allowing your dentist or prosthodontist to make a denture that fits.
