Oral surgery at its best! Bone replacement and dental implantation
The basic question about dental rehabilitation is whether the patient has enough bone to get dental implants or not. The following will be interesting if the answer is not. If there is not enough bone for the rehabilitation, then usually it is necessary to replace the bone. There are different options for this, the application / selection of which method is the more appropriate is determined by the degree of bone deficiency, and the final fixed denture we want.
The most and the least frequent options
- Bone augmentation with BioOss artificial material
- Bone transplantation from the jaw bone
- Bone transplantation from the hip bone
- Bone transplantation from the fibula flap
Healthcare is undergoing tremendous development and of course, dentistry is no exception! It is a fact that, thanks to the achievements of 21st century, that many unimaginable or unworkable treatments, nowadays have become a routine task. Together with dental science, techniques, tools, and materials have evolved, bringing number of potential options to life. One such prominent area is the dental and oral surgery, including bone replacement and transplantation, for which it is worthwhile to pay attention. Good bone is the basis for dental implantation, with other words, tooth replacement. In case of bone deficiency, the deficiency should be compensated. This has several levels and may be different for each patient. Our clinic is one of the very few in Hungary and in Europe where our doctors can perform almost every level of bone grafting and bone transplantation! Let’s look at these levels now.
By default, when the patient intend to complete the lack of teeth as soon as possible and there is usually enough bone, then we just insert the dental implants, and after 3-4 months of ossification time, we finish the prosthetic work, which means we make the fixed teeth/crown or the bridge or a complete circular bridge/denture. This treatment is carried out under local anesthesia. The tratment it self is totaly painless and it is many time less traumatic than a single tooth extraction. The surgical area, 1-2 weeks after the dental implantation can be still sensitive!
- Bone augmentation with BioOss artificial grafting material. This is probably the first level of bone deficiency. We are talking about when the amount of the missing bone is so small, that can be replaced with just the BioOss bone grafting material, without using from your own bone. The integration or osification takes 4-6 moths, after this time, the dental implant/s can be placed. The dental implant also needs an integration time, which is about 3-4 month. After this we continue with the prosthetic works, when we make the teeth/crowns or dental bridges. The bone grafting and implantation is performed under local anesthesia and is totaly painless, however the surgical area, even 1-2 weeks after the operation can be still sensitive and the face of patient can be slightly swollen.
- Bone transplantation from the jaw bone – this is the next level of the bone loss. It means, that the amount of the missing bone is bigger and the BioOss material is not enough to replace all, so you need some of your own bone. In most of these cases the donor area is the jaw bone from where the oral surgeon removes little slices or blocks. These blocks are fixed with micro-screws to the missing area. The osification or integration, takes about 5-6 months. After that, everything follows as it was at the previous level, so the dental implants are placed first and 3-4 months later we finish with the prosthetic dental work. This oral surgery is painless too, but takes more time, so it is longer. Because of this, the patient has the choice of having the surgery under local anesthesia or to select the full anesthesia. Further reasons to go for the full anesthesia are the physical and psychologiacal condition of the patient or when she/he has phobia of the dentist or for example the hypersensitivity, just to mention few. The surgical area, even 1-2 weeks after the operation can be still sensitive and the face of patient can be slightly swollen.
- Bone transplantation from the hip bone – When this level of the bone loss occurs, so when neither the artificial material (BioOss), neither the jaw bone is sufficent to build up the bone to receive the dental implants, we need to find another donor area and the ideal area is the hip bone. The hip in most of the cases provides significant quantity of bone. The surgery takes about 3 hours and during it, the necessary amount of bone is taken from the hip and it is transplanted to the part of the jaw, where the patient has the bone deficiency. In this case too, the bone slices or blocks ar fixed with micro-screws. Once the oral surgery is finished, the process coincides with the previous one. The bone osseointegration time is aprox. 6 months, after which the implants will be fitted and another 3 months later is followed by the prosthetic work. The surgery is performed only under full anesthesia and it is completely painless. The first 2-3 week of the recovery period, principally during the first few days, the areas of the intervention (hip and jaw) will be quite sensitive. Walking will be more difficult too at the beginning for 3-5 days.
- Bone transplantation from the fibula flap – This serious mandibular reconstruction is now a solution for the patients, who do not have enough bone for some reason and the previously mentioned bone replacement forms (BioOss, jaw bone, hip bone) are also insufficient. It is the case, when the vertical deficiency of the mandible/jaw exceeds the 1 cm and the horizontal loss is up to 5 cm or more, so it is inevitable to look for another, more abundant donor area. Taking everything into consideration, the fibula is an ideal source which offers the necessary amount of bone to make this size of reconstruction. This large and complex surgery takes about 3-4 hours and it is performed in full anesthesia, under hospital conditions! Great advantage of this method is, that because of the large size of the transplanted bone, most of the cases is possible to place the dental implants aswell at the same time, and if it is so, then the bone and the implants integrate together. The other advantage of this vertical augmentation is that it’s possible to make a completly aesthetical and natural porsthetic work, since the lips are optimally and naturally suported by the teeth! Also the large wrinkles around the mouth are significantly reduced, because it’s possible to make the teeth in a right and proper size, avoiding the excessivly long sizes, which would not look natural. Becuase of the full anesthesia the operation is totaly painless! Of course the first 2-4 week of the recovery period, principally during the first week, the areas of the intervention (fibula and jaw) will be quite sensitive.
General anesthetic surgeries are always performed in the presence of an anesthetist and his/her assistant! The general anesthesia is always preceded by mandatory tests, including full laboratory testing, chest X-ray and ECG. Knowing the results of these tests, a consultation with the anesthetist is performed prior to every surgery.
La Porta Dental – UNIKLINIK dental surgery team
specialist in dental and oral diseases, dentoalveolar oral surgeon specialist
dentist, dentoalveolar oral surgeon specialist
medical director, dentoalveolar oral surgeon specialist
DR. TAMAS SASS
specialist in dental and oral diseases, dentoalveolar oral surgeon, face-mouth-jawbone surgeon specialist, general doctor
dentist, dentoalveolar oral surgeon specialist
For detailes and further information on prices, on the procedure, on the surgery or to make an appointment, please contact us!
For appointments please contact us:
Tel: +36 30 299 0769 (HU)
Tel: +44 7448 155215 (GB)
Tel: +353 85 777 58 57 (IE)