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Tooth Implant Preparation

When a tooth is missing, the bone tissue that was supporting it begins to shrink, or resorb. If you have been missing a tooth for some time, you are very likely to have experienced some bone loss in the area where the tooth once stood.

While dental implantation can be used to replace missing or diseased teeth, in order for the technique to be successful a patient must have enough bone in the jaw to support the placement of an implant into the jaw bone. In the past, too much bone loss made some patients poor candidate for dental implants. Now, however, bone recontouring techniques can be used to prepare the mouth for dental implants.

Bone recontouring is accomplished with bone grafting or distraction osteogenesis. It most often involves building up the edge, or ridge of the jaw either to widen it, or to increase its thickness. Sometimes, particularly in older patients, the sinus cavity (just above the maxilla on either side of the nose) enlarges and the bone in the back of the maxilla resorbs; grafting is used to essentially lift the sinuses and thicken the jaw bone. In rare cases, the nerve passing through the jaw might be positioned higher (closer to the gums) than usual - an oral surgeon might recommend a bone recontouring procedure to reposition this nerve, to prevent it from getting damaged by the implantation procedure.

Diagnosis

A detailed oral examination is done to develop a treatment plan for patients who have chosen to have dental implants. The dentist or oral surgeon will use imaging tests such as x-rays and often CT scans to get an accurate picture of the patient's mouth. Impressions and molds of the patient's mouth will also be made. This will show whether bone augmentation or other procedures need to be done to prepare the patient's mouth for implants.

Treatment

Bone grafting is best done using the patient's own bone - this is called an autograft or an autogenous graft. Bone can be taken from the mouth area, for example behind the molars, the chin, or the back of the upper jaw. For larger grafts, the most common donor area is the hip. Bone grafts taken from animals or cadavers are also sometimes used. In addition, a synthetic material has been developed that has properties similar to natural bone and can be used for small grafting procedures.

Bone grafting surgery is usually an out-patient procedure. During the surgery, the soft tissue is lifted to expose the bone, and the bone grafting material, either natural or synthetic, is placed at the site. Sometimes, a special protein is added which stimulates bone generation. The surrounding soft tissue is then sutured back into place.

Patients experience some soreness, swelling, or light bleeding after the surgery. Applying ice, or taking oral pain medications, should be sufficient to relieve any discomfort. Patients will need to take extra care in keeping the mouth clean after the surgery, as instructed by their surgeon.

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