Bone augmentation may be necessary if there is no longer enough bone to securely anchor dental implants in the jaw .
Nowadays, implants can usually be placed without bone formation
In the past, when there was pronounced bone loss, dentist surgeons avoidd building up the jawbone when implants were to be placed. Fortunately, today we can make better use of the bones that are still there and therefore more and more often do without a bone structure. Modern 3D diagnostics and implant planning, on the one hand, and the introduction and permanent improvement of ultra-modern implant systems and implantation procedures, on the other, contributed to this positive development.
In the few cases that still require bone grafting, this is often done during the implantation. A longer inpatient stay is not necessary for this. The best-known methods of bone augmentation include bone apposition and the sinus lift. Modern surgical techniques such as piezosurgery or laser surgery, as well as the option of having the procedure carried out under general anesthesia or sedation , take all of its horror away from bone formation. A bone Augmentation is not painful. A sinus lift in connection with autologous blood therapy , for example, ensures faster ossification and wound healing, as the biomaterials used are first mixed with the body's own cells in order to activate natural self-regeneration.
Bone augmentation is often necessary in the upper jaw
A bone loss can affect the upper and lower jaw equally. However, bone loss is most common and clearest in the posterior and molar area of the upper jaw. The bone tissue in the upper jaw is softer and more porous than in the lower jaw. This is why the bone breaks down faster there, making it harder to anchor implants here.
The maxillary sinuses are located above the posterior teeth in the upper jaw. If the jawbone breaks down in this area after tooth loss, the floor of the maxillary sinus also sinks. When inserting dental implants, without prior bone formation, we therefore run the risk of damaging the floor of the maxillary sinus and the sensitive mucous membrane (Schneider’s membrane) above it. If the mucous membrane is injured, it can easily lead to inflammation in the maxillary sinus, which among other things creates the risk of losing the implant later.
Means and methods of jawbone augmentation
If our 3D implant planning shows that an implant is not surrounded by at least 5 mm of bone in the planned position, the possibility of inserting the implant into the bone at an angle of up to 45 ° can be checked. This enables better bone apposition of the dental implant. Only when this is not possible is bone grafting necessary.
Which means are used to build up bone in the upper or lower jaw?
Which of the bone grafting methods listed below we ultimately choose depends on the amount of bone still available and the initial situation of the jaw.
Bone apposition is a bone building method that we mainly use for smaller bone defects. Bone meal or bone chips are used as building materials. These are obtained through the drilling process or taken in the immediate vicinity of the operating theater area. Autologous bone contains vital cells that are necessary for the growth of new bone. With this method, the bone building material is attached directly to the bone defect.
The area where the bone was deposited is covered with a special collagen membrane. The collagen layer forms the necessary barrier between the bone and the overlying mucosal layer during the healing period. Mucosal cells grow faster than bone cells. The separation of the two areas prevents the mucous membrane cells from colonizing the bone cells and thus jeopardizing the success of bone formation. The collagen membrane, which is also used in other bone building methods, is completely broken down by the body.
Advantages of bone apposition
very gentle (no surgical removal of own bones necessary)
The enlargement of the bones
Bone Spreading and Bone Splitting
Bone spreading and splitting are used to widen a too narrow alveolar ridge, i.e. the tooth-bearing part of the jawbone (alveolar ridge). The operative stretching or splitting of the jawbone is also called "osteotomy".
With the so-called bone spreading, the bone is gently pushed apart with certain instruments and the space that is created is filled with bone substitute material. The bone spreading is only suitable for the soft upper jawbone.
The difference between bone splitting and bone spreading is that the bone is not spread before the bone material is introduced, but rather carefully split.
Depending on the requirements, the dental implant can either be inserted in one go with the bone structure or after a healing phase lasting several months.
The bone block method
Bone block transplant
The bone block method can be used for larger bone defects or pronounced bone loss. In the case of bone block transplantation with autologous bone, bone blocks are removed from the jaw , chin or (more rarely) the hip bone and attached to the bone area to be built up. The body's own bone block is attached with small screws. After a healing time of around 3 months, the screws can be removed and the implants inserted. Any minor bone defects that may still exist can then be repaired in the course of the implantation using the conventional bone apposition method.
The botiss bonebuilder® technology is a particularly innovative form of bone block transplantation. It is used in both the upper and lower jaw. This bone grafting method is particularly suitable for three-dimensional bone defects, i.e. in cases in which the bone is too narrow and too low at the same time. The special thing about the botiss® bone block is its highly individual shape.
The basis for the provision of the individual bone block is the "botiss bonebuilder® & materialize SimPlant® technology". On the basis of three-dimensional DVT images and with the help of the Simplant 3D planning software, the necessary piece of bone is first constructed on the computer. The planning data are then converted into a so-called "milling file" and sent to the manufacturer. Based on the data, he creates an individual bone block and sends it in sterile packaging to Oral Surgery in Herne. The botiss bone block is usually human donor bones.
The advantages of the botiss bonebuilder® technology:
perfect fit of the individual bone block
no further adjustment necessary, thereby
economical and significantly shorter treatment time
particularly gentle (minimally invasive), as no own bone removal is necessary
even better contact between the transplant and the patient's own bone
Distraction osteogenesis (also called callus distraction) is a bone building process that is extremely rarely used. It is used when the bone height is too low or to lengthen the bone.
With this method of bone augmentation, the oral surgeon divides the bone area to be treated horizontally. With the help of a distraction device (lat. Distrahere = pull out), the two superimposed fragments are pulled apart by up to 1 mm every day until the desired bone height is reached. In the space created in this way, new bones (callus) can gradually form. The distraction device is only removed when the newly formed bone has sufficiently strengthened. The entire process of bone augmentation with distraction osteogenesis takes three to four months. After this time, the bone is firm enough to hold the implants.
The advantages of distraction osteogenesis:
gentle procedure (no autologous bone removal necessary)
high success rate
Soft tissue is also stretched
no additional interventions in the soft tissue necessary
Aesthetic shaping of the soft tissue in the area of the later implants is possible
Sinus lift (sinus floor augmentation, sinus floor elevation)
Structure of the jawbone
In the lateral upper jaw , the alveolar ridge is bounded by the floor of the maxillary sinus (sinus). If bone loss occurs in the lateral upper jaw , the floor of the maxillary sinus above it automatically lowers and implants no longer hold. In order to create a sufficient implant bed here, the sinus lift procedure is used, which is preceded by a comprehensive 3D diagnosis to determine the individual bone situation.
How does the sinus lift work?
The sinus lift is a method with which the lowered floor of the maxillary sinus is moved back upwards. This is done by lifting the mucous membrane above it (Schneider's membrane) and introducing bone material into the cavity created in this way. During the subsequent healing phase, the introduced bone material is converted into resilient bones.
What sinus lift methods are there?
With the sinus lift, a distinction is made between external and internal sinus lift. The difference between the two techniques is the way the oral surgeon accesses the maxillary sinus.
External sinus lift
With the external sinus lift, access to the maxillary sinus is laid from the oral vestibule (area between the cheeks and the upper jawbone). Under certain conditions, the external sinus lift and the insertion of the implant (s) can take place in one treatment session.
Internal sinus lift (also: small sinus lift, small sinus floor augmentation)
With the internal sinus lift, access to the maxillary sinus is via the implant tunnel, which is also used for the implant. However, the implant tunnel is not drilled through completely so that the floor of the maxillary sinus and its sensitive mucous membrane are not damaged. Instead, the drilling process ends just before the floor of the maxillary sinus begins. The remaining thin layer of bone is removed in the Herne practice clinic with an ultra-fine ultrasonic diamond (piezo surgery). The operated area, which is filled with bone material, is tightly closed by the implant that is then screwed in.
Sinus lift with piezo surgery
Ultrasound-based piezo surgery (also known as piezo surgery) is a very modern and extremely gentle surgical procedure for processing bones. It has been used successfully in the Herne practice clinic for a long time. The handpiece of the device used actually reminds a bit of an ultrasonic t
oothbrush. It is suitable for various uses and therefore has different attachments. Piezo surgery is used especially for sinus lifts,
in order to remove bones, i.e. to place a bone window to the maxillary sinus in the area of the maxillary sinus floor, and to lift the mucous membrane overlying the floor of the maxillary sinus. to raise.
As part of piezo surgery, the bone is removed with high-frequency ultrasonic vibrations without damaging the soft tissue. When lifting the maxillary sinus lining, the oral surgery dentist makes use of the water pressure of the ultrasound-based device.
Compared to conventional techniques with rotating drills or oscillating saws, the piezo method is extremely gentle and thus promotes faster wound healing.
The “socket preservation” bone augmentation method is used in the aesthetically demanding front teeth area. The bone compartment is filled with bone material immediately after the tooth has been removed. This prevents the gums from growing into the tooth socket. The socket preservation process ensures that the existing bone and soft tissue structures are preserved, which is particularly important for the aesthetics of the subsequent implant restoration.
Bone build-up under local or general anesthesia
As a rule, local anesthesia is sufficient for bone augmentation surgery. In complicated cases or if you are very afraid of the dentist, the Dentist can also offer you partial or general anesthesia and sedation on request. The anesthesia and sedation makes an experienced anesthesiologist with us. He will also guide you through the wake up process. In addition to general anesthesia, we also use twilight sleep sedation and nitrous oxide sedation.
Bone substitute material
Normally following biomaterials are used for bone augmentation:
Autologous bone material: This is how you call your own bone
Allogeneic bone material: This comes from a human donation.
xenogenic bone material: is usually of animal origin.
synthetic bone material: is produced artificially
Which material is ultimately used depends on your individual initial situation, which we determine in the context of clinical and radiological diagnostic procedures. You can find more information about the different bone materials by clicking on the following links.
When it comes to our own bone used for bone formation, we distinguish between:
Bone meal or bone chips which are produced during drilling
Bones that we take from the area to be operated on or from another part of the jaw
Bone blocks that are taken from another part of the body, such as the jaw , chin or hip bone
We try to avoid bone harvesting from the hip whenever possible, as it involves a major operation under general anesthesia. In fact, it is very rarely necessary.
The advantages of using autologous bone are obvious:
no risk of rejection
highest osteoconductivity (ability to serve as a framework for the formation of new bones and blood vessels) highest osteoinductivity (ability to stimulate new bone formation)