 Over a period of time, the jawbone associated with missing teeth is resorbed. This often leaves a condition in which there is poor quality and quantity of bone. In the past, these patients had few choices and were not candidates for placement of dental implants. Anatomical defects, narrow ridges and/or a low sinus floor, often required multiple staged procedures with lengthy healing intervals. “State of the art” techniques allow for simultaneous placement of an appropriate diameter implant and a reduced interval to restoration. We use ridge expansion in combination with sinus floor elevation, block bone grafting, distraction techniques, “plastic” gum procedures and the use of platelet-derived growth factors to enhance wound healing.
Severe skeletal bone loss causes a debilitating loss of function, as well as, and cosmetic deformities such as, loss of lip support, wrinkles, “witch’s” chin and “gobbler” neck . Many people have the ongoing difficulty and discomfort of poor fitting or unattractive dentures, pain from pressure on the jaw nerve, facial wrinkles and sunken lips. Some patients have had unfortunate injuries or removal of lesions, causing defects that severely impair function, diet and health. Whatever your circumstances, grafting, implant reconstruction and other esthetic treatment can offer you a “high tech” solution to restore your confidence with natural function and beauty.
Grafting
Using your own bone or a bone substitute may be necessary to develop the needed amount of bone around the implant. This may be necessary prior to implant placement (in cases of severe bone loss) or at the same time as implant placement. Some types of grafting may require a 4-6 month healing period. If a defect exists in the bone around the implant, a barrier membrane may also be necessary to keep out the faster growing scar cells while the graft heals.
Treating a Low Sinus
In the upper jaw after tooth loss the sinus remodels lower which reduces the height of available bone for implant placement. This can vary significantly from patient to patient and with the length of time since tooth loss. Elevation of the sinus floor or placement of a graft can allow for implant placement. In some cases implant can be places at the same time as elevation or after healing of the graft.
Treating Narrow Ridges
After tooth loss the bone ridge that supports the tooth remodels and reduces in size. The rate of the bone loss varies with the length of time, site and patient. Certain medical conditions can affect the rate of bone loss including osteoporosis, diabetes or other conditions. The bone loss occurs at first by a loss of ridge width. With early bone loss slightly narrower implant (narrow platform) can be placed if it is in acceptable alignment with the opposing tooth and there will not be an unacceptable size difference with the final crown. The implant requires a normal margin of bone of 1.5 mm to 3 mm surrounding it for integration and long-term stability. Otherwise the bone must be reestablished to the dimensions before tooth loss.
 We can complete development of the site using several grafting techniques to restore volume including grafting with bone products manufactured from bovine or man made substitutes. In some cases the best bone is from another site located close by in the jaws. It may be necessary to use barrier, like collagen to contain the graft particles and protect the graft during healing. The ridge can also be widened by dilatation or expansion with a special technique that then allows healing from within the bone cavity, just like an extraction site. This allows faster healing and does not require any grafting materials. Ridge expansion is a very gentle and elegant technique; however, it does have some site requirements to be effective.
Managing Severe Bone Loss
In cases of severe bone loss, we utilize several techniques to minimize expense and treatment time. These procedures may be performed separately or together, depending upon the individual’s condition. There are several areas of the body that are suitable for obtaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chine or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be obtained from the hip or the outer aspect of the tibia (lower leg) just below the knee. These surgeries are performed in the office surgical suite under IV sedations, or in select instances, at out patient surgery. After discharge, rest for several days is recommended and limited physical activity for one week or as necessary.
Functional and Cosmetic Correction of Lip, Chin and Neck
The Submental (under the chin) Approach
This approach allows grafting to restore a more normal bone height with or with out implant placement. The advantages are accelerated healing and less risk of complications than those of grafting from an oral approach. Additionally, specially designed neck lift, liposuction and/or chine muscle reconstructions techniques can also be utilized to regain immediate lower lip function (including puckering and whistling) as well as a youthful neck and jaw line. Patients tell us how thrilled they are with the improvement in function and how happy they are with their new, younger look.
Neck Lift and Functional Muscle Reconstruction
In patients with a significant excess of skin, the chin area is very amenable t a lifting technique. After removal of excess fat, removal of skin is completed to allow advancement for tightening the neck area. With progressive bone loss the location of the facial muscles which control lip position and function can be lost, severely compromising speech, function and with devastating appearance of aging. Muscle Repositioning immediately restores lower lip function (including puckering and whistling) and a youthful neck and jaw line.
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