WHAT IS A BONE GRAFT?
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The science of dental implants is based on the concept of osseointegration, which refers to the adherence of the implant to the jaw bone. It is important to have good quality bone that is thick and dense for a successful implant placement to be achieved. In most cases of tooth loss, some type of associated bone loss occurs, or bone atrophy. To make up for this loss, there are bone replacement procedures known as Bone Grafting.
WHAT ARE THE TYPES OF BONE GRAFT?
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There are basically three main sources of bone for grafting:
Autogenous bone: This is bone that originates from the patient’s own bone. This means that it would be sourced from a different part of the body called a donor site. There are intra-oral and extra-oral donor areas, inside the mouth or outside. What will define whether the bone removed will be from inside the mouth or from an area outside the mouth is the amount required for bone replacement. For most autogenous bone grafting cases, the bone is derived from elsewhere in the mouth, commonly close to the implant site. In rare cases where larger quantities of bone are required, such as in trauma cases or patients requiring advanced reconstruction surgeries from post-cancer treatment, grafting is performed in a hospital setting, generally sourcing the bone from the iliac crest (pelvis) or the cranial bone under general anaesthetic. You would not be seeing your neighbourhood dentist for such grafting procedures!!
Allograft bone: This is bone that originates from someone else’s bone. Highly regulated bone banks or tissue banks are used to source the bone for dental grafting. This bone is sterilized, irradiated and completely acellularized in order to be used safely. Rejection rates are practically non-existent and this treatment modality has become a standard of care for most dental grafting procedures. Allograft is used in 90% of dental and implant-associated grafting cases, and to great success.
Xenograft bone: This is bone that originates from the donor bone of another species. Usually, the origin is bovine or porcine. This option also provides similar advantages to allograft bone, although the compatibility of human bone provides better results when dealing with future implant placement.
WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF AUTOGENOUS VS NON-AUTOGENOUS BONE GRAFT?
Between the three available options, each has advantages and disadvantages. However, based on literature reviews, research is unanimous in stating that autogenous bone is considered the “Gold Standard”, not being surpassed by any other type of biomaterial. The key disadvantage is the need to create another surgical site, called the donor area, which leads to added post-operative pain and extra healing time. This is why allograft is used so predominantly in place of autogenous bone harvesting.
WHAT LEVEL OF ANESTHESIA IS REQUIRED FOR BONE GRAFT SURGERY?
Considering that the most convenient, effective and pain-free strategy for bone reconstruction is the use of allograft bone, surgery involves one single site: the surgical site. All that is required for bone replacement with this procedure is local anesthesia. This modality offers comfort to the patient and total minimization of pain sensation. If the choice is for an extra-oral donor area, the surgery would be performed in a hospital environment, under general anesthesia.
CAN ANYONE UNDERGO BONE GRAFT SURGERY?
As with any surgical procedure, it is necessary for the surgeon to do a thorough overview of the general health status of the candidate patient who will be undergoing the bone graft procedure. The patient must be in general good health, taking into consideration medications the patients is on and immunocompromising factors such as cancer. In addition to the general health review, it will be important to assess oral health. Alveolar bone restoration through bone graft surgery needs to be performed in an environment with little to no caries, fractured teeth, inflammation or gum infections. That is, the patient must be in good general health and oral health.
IS THERE AN AGE LIMIT FOR THIS SURGERY?
There is a minimum limit, but there is no upper limit. That is, advanced age is not a contraindication for bone graft surgery. Many elderly patients, in good health or otherwise, are able to undergo this surgery. However, surgery should not be performed on children in the growth phase, as it may alter the pattern of bone development. Generally, the minimum age for females is 17 and for males it is 18.
IS THERE REJECTION IN BONE GRAFT SURGERY?
Regardless of the surgical modality, whether using autogenous or allograft bone the chance of rejection is practically non-existent. Detrimental immunological reactions really do not play a part in the process. There may be some graft loss due to inflammatory or infectious processes, but this can be recouped with added graft if necessary.
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Marchwood Dental Clinic specializes in implants and aesthetic treatments, focusing on the oral and dental health of patients in Kanata, Dunrobin, Carleton Place, Almonte, Carp and all of West Ottawa. We offer many treatment options and alternatives with cutting-edge technology to guarantee the quality of our service.
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