A natural and healthy bone is ideal for providing support to any tooth replacement. But generally, alveolar bone starts to resorb after tooth extraction.
In such cases, bone augmentation helps to rebuild the bone structure and provide adequate quality and strength for tooth replacement procedures especially implants.
Bone augmentation is commonly done using bone grafts. The grafts can be natural or synthetic. In the process of bone augmentation, bone grafts are securely placed on to the existing bone.
The existing bone then starts to adhere to the newly placed bone graft with time. In this way, a healthy bone structure is prepared for placement of implants.
Usually in the mandible, when the length of the bone is not ideal for implant placement even after bone augmentation, the inferior alveolar nerve is repositioned to make space for the implant. Such a procedure is called nerve repositioning.
Today, we will discuss the two most critical surgical procedures in the field of dentistry and learn how these procedures amplify the results of tooth replacement.
What are bone augmentation and nerve repositioning?
Bone augmentation is a term used for a series or group of procedures that are performed to build the bone of the jaws. Most commonly, this procedure is done before implant placement.
Bone augmentation typically involves a bone graft which can be taken from your own body or be processed by artificial means. This graft is placed on the space around the existing bone to allow its fusion and bonding. (1)
It takes several months for the graft to fuse and strengthen. During the process of bone fusion, the graft may trigger the surrounding bone to grow around it or allow the cells to expand into the graft.
Typically, nerve repositioning is done in the lower jaw. The inferior alveolar nerve forms the prime neural supply to lower lips and chin. (2)
In circumstances where the placement of an implant requires more room to stabilize within the jaw, nerve repositioning helps to create extra space for the implant. However, nerve repositioning can only be performed under certain limitations –
- It is done just in the lower jaw
- The procedure is performed only in cases where the molars or second premolar is missing and requires space for implant placement
Nerve repositioning is an aggressive approach which may cause postoperative numbness of the lower lip and jaw after surgery.
What causes bone loss?
Bone augmentation is a surgical procedure done to revitalize the quality and quantity of bone in the jaw to allow implant placement.
Bone loss is often a common incidence caused by many factors –
- Gum and periodontal disease
- Injury or trauma to the face
- Tooth Extractions
- Denture wearers undergo progressive bone loss with time
What are the clinical procedure of bone augmentation and nerve repositioning?
Procedure for bone augmentation
Modern bone augmentation procedures are minimally invasive and painless treatment options. An oral surgeon or a periodontist is the right person to perform this procedure clinically.
Bone augmentation can be done immediately after tooth extraction or when the patient decides to get an implant. Augmentation of bone after extraction show better results of healing. (3)
In case of bone loss over a prolonged time, the procedure begins as follows –
- The lower jaw is numbed with local anesthesia
- An incision is made on the gum to reflect it and expose the bone
- The bone graft is placed and secured well with the existing bone. Collagen and proteins present in the bone graft encourages bone growth in the jaw
- The area is covered by the gum tissue and sealed with sutures
Procedure for nerve repositioning
Nerve repositioning is an aggressive procedure performed separately depending on the patient’s condition. The procedure is performed as follows –
- First, the outer section of the cheek and the lower jaw bone is removed to expose the nerve and its vessel canal (4)
- The nerve and vessel bundles are isolated in the area and pulled to one side
- The implant is placed while the nerve and vessel bundles are moved away from their original position
- After implant placement, the nerve and vessels are released and placed over the implant
- Surgical access is filled with bone graft to allow recovery and the area is closed and sutured back
Which bone graft materials are used in bone augmentation?
Bone grafts can be taken either from parts of one’s own body or produced artificially in the lab. (5)
Natural bone grafts
These grafts are attained from the body of the patient. Bone grafts for the maxillofacial region are taken from the areas of the chin, third molar region or the bone behind the last tooth in the upper jaw.
In extensive cases, good quality bone grafts can also be taken from the hip bone or the outer aspect of the tibia in the knee.
Synthetic bone grafts
Synthetic or alloplastic bone grafts are prepared from bones of cadavers or animal bones. The bone is disinfected and processed to ensure no bacteria and diseases are passed on to the patient’s mouth.
How to take care of your oral health after a bone augmentation procedure?
It takes around six to nine months for the bone to heal completely after surgical augmentation. The dental specialist will hand you a list of instructions to follow at home.
The dentist will also prescribe specific antibiotics and pain medications to provide comfort during the healing process.
One of the essential steps is to maintain good oral hygiene. For that, you can use an antibacterial mouthwash and rinse your mouth daily.
Take away message
The process of bone augmentation may sound invasive and, but it is the best method to get a natural smile.
Bone augmentation and nerve repositioning have become common dental options for patients who wish to get an implant as a permanent fix to their smile.
An oral surgeon or a periodontist is the best person to seek consultation for both of these procedures.
As crucial as these treatments are for the betterment of your oral health, maintaining them for life long is also essential.
Follow all the postoperative instructions given by your dentist and visit them regularly to keep a check on the health of the implant as well the gums and teeth.