Ridge deformities of the upper and lower jaw can leave you with inadequate bone and tissue thickness for either an aesthetic and functional bridge or dental implant restoration. The defects may have been caused by trauma, developmental defects, periodontal disease and wearing dentures.
Ridge augmentation procedures have been shown to greatly enhance the cleansability and appearance of your restorations. They increase your chance for long-term successful dental implants, both aesthetically and functionally.
- Soft tissue ridge augmentations are performed to enhance the cleansability and aesthetics of a deficient site prior to its final restoration. During this procedure, an incision is made to expose the bony ridge. A soft tissue graft is then obtained either from a suitable site in your mouth and/or a soft tissue substitute and inserted into the area. The gum tissue is readapted over the soft tissue graft and sutured into place.
- Hard tissue ridge augmentations are performed to recreate adequate bone dimensions prior to dental implant therapy. The hard tissue augmentation can also be done in combination with a soft tissue augmentation to simultaneously enhance the soft tissue profile of the deficient site. After the incision is made and the gum lifted away, the bony defect or bone substitute is placed in to build up the ridge. A membrane may be adapted over the bone graft based on individual defect morphology. Depending on defect size, an average bony healing and maturation time of 3-9 months is allowed before dental implants can be placed. In some cases, the implant can be placed at the same time as the hard tissue ridge augmentation is performed.
Extraction Site Preservation
There is a special type of bone surrounding your teeth. This bone is called alveolar "ridge" bone (jawbone), and exists solely to support your teeth. As soon as the tooth is removed, this bone begins to degenerate and "melt away." The overlying gum tissue melts away with the alveolar bone and thins out as the ridge flattens. This occurs in two dimensions. The first is loss of horizontal width caused by the collapse of the bone surrounding the socket. This makes the remaining ridge narrower than when the tooth was present. The second is a loss of vertical height. This makes the remaining bone less “tall”. This process is faster in areas where you wear a partial or complete denture.
You have many options to prevent this, and it is important that you consider them BEFORE any teeth are extracted. Some of these procedures are best performed at the time the tooth is removed.
When you need to have a tooth or teeth extracted, whether it is due to tooth decay, fracture, abscess, gum disease or traumatic injury, a socket site preservation is recommended to preserve as much of your underlying jawbone as possible for your future restorations.
You will have several choices for replacing the newly missing teeth. All of the options rely on bone support and bone contour for the best function and aesthetics. Here is a list of the possible options:
- Dental Implants: These are root-shaped supports that hold your replacement teeth. The more bone support you have, the stronger the implant replacements will be. In some cases, the bone can degenerate to a point where implants can no longer be placed without having more complex bone grafting procedures to create the necessary support. Obviously, preventing bone loss is much easier than recreating the bone later.
- “Fixed Bridge”: This is a restoration that is supported by the teeth adjacent to the missing tooth space. The replacement tooth (or pontic) spans across the space. If the bone is deficient, there will be an unsightly space under the pontic that will trap food and affect your speech.
- Other replacement alternatives include removable partial or full dentures. These often perform better with more supporting bone as there is added support against dislodgement.
There are two important phases in retaining your alveolar ridge during and after the tooth extraction. Non-traumatic extraction techniques are designed to preserve as much bone as possible and reduce bleeding and discomfort. In addition to non-traumatic extractions, and key to preventing the collapse of the socket, is the addition of bone replacement material to the extraction socket.
There are several types of bone grafting materials and techniques. Dr. Mirzayan will discuss the most appropriate one with you. After the tooth is extracted, the socket will be packed with bone or bone substitute and covered with a absorbable membrane then suture. Early on, the grafting material will support the tissue surrounding the socket, and in time will be replaced by new alveolar bone. This bone will be an excellent support should you choose later to have dental implant-supported replacement teeth.
Although the bone created by socket grafting supports and preserves the socket, it will not do so indefinitely. Placing dental implants three to twelve months after the extraction and socket grafting will provide the best long-lasting support for preserving your jawbone and allow you to function as before. Otherwise the graft may “melt away” or resorb over time.
In some selected cases it is possible to actually extract the tooth and place the dental implant at the same time. Dr. Mirzayan will discuss this option with you if it is a viable alternative.