Dental Implant Series Part 3 – Tissue Reconstruction Around Implants

Why Reconstruct?

The success of a dental implant largely depends on the process of natural growth of bone surrounding the implant. For this, and to provide an initial holding strength, a minimum amount of bone must be present on the site of the proposed implant. Tissue reconstruction before the placement of a dental implant may be done before or even during the implant process, depending on the decision of the surgeon and other patient factors.

 

Hard tissue Reconstruction-Grafting

Bone mass requirement for an implant depends on the size and position of the implant. It also depends on the nature of the prosthesis the implant has to support-whether single tooth or multiple. It also depends on whether the implant is connected to other implants for sharing the load. A rule of thumb goal, however, is a minimum bone height of 10mm, and minimum width of 6mm is required.

Bone deficiency classification: For standardization, bone deficiencies may be classified by letter grades A-D as:
• 10mm or more A
• 7mm to 9mm B
• 4mm to 6mm C
• 0 mm to 3mm D

If bone depth or width is insufficient for the planned implant bone grafting can be done. Two types of sources exist for the graft material.

 

Grafting Techniques

Many techniques have evolved over the years to ensure sufficient height and width of bone for the implant in mind. Guided bone graft augmentation is the most popular. Two sources are options for the graft material. The safest is autograft or harvested bone tissue, where bone is ‘harvested’ from the body of the patient himself. Suitable sites for harvesting are the back of the lower jaw, or the pelvic region (iliac crest).

Grafting for bone replacement and tissue reconstruction come from the Iliac crest (pictured above.)

Allograft (allo, meaning other) means the additional bone required is taken from another donor. Alternatively, artificial (cadaveric) bone pieces are used as a scaffold for natural bone growth.

 

Common Procedures for Bone Augmentation

Three types of procedures are common:
• Sinus Lift
• Alveolar Augmentation-Lateral (width increase of bone)
• Alveolar Augmentation-Vertical (height increase of bone)
Other Procedures
Other procedures, rather more invasive, are available for larger bone defects. These include:
• Shifting the inferior alveolar nerve to create space for fixture placement
• Onlay, where bone from the iliac crest, or if possible, another larger source may be used.
• Microvascular graft: Blood supply to the graft material is also transplanted with it and connected to the local bone supply.

 

Reconstruction of Soft Tissue or Gingiva

The implant needs strong gums attached to it for good long term health. Also, for esthetic reasons, a band of plump gingiva is necessary to fill up the interdental region on either side. If sufficient thickness of gingiva is not present it can be augmented with a graft of soft tissue. Four methods are available for soft tissue graft:

• Adjacent tissue can be shifted towards the implant
• Gingiva can be transplanted from the palate
• Deeper connective tissue can be transferred, again from the palate

The selection of a particular method will depend on the implant parameters and the local conditions.

 

Ask Your Local Dentist

Though all this sounds invasive and complicated, many patients that need tissue reconstruction paired with implants have claimed that it was less painful or uncomfortable than getting fillings done. (If extractions are involved, however, it tends to be a longer healing time.) Some people choose to have reconstruction done prior to implantation, while others get everything done all at once. Your local Fort Worth Dentist can help you make a plan that best suits your schedule and oral conditions. we can also schedule an oral cancer screening or dental exam prior to your procedure.

 

Next Monday, we’ll be chatting about a patented type of implant that is the ultimate complete tooth replacement system.