Getting to grips with bone grafting
Featured Products Promotional FeaturesPosted by: Dental Design 20th April 2024
For many dental professionals, implantology is an area of immense interest that fuels targets and ambitions throughout their career. As you further your abilities, and want to transform your clinical offerings, you may want to look at taking on more complex cases. These will often involve bone augmentation procedures.
Identifying those at risk
The surgery is well-accepted in modern dentistry, and is required for one in every four dental implants – some estimates even push this to 50% – whilst the total number of operative procedures is expected to increase by 13% annually.[i] These numbers suggest an ever-growing demand for clinicians to provide augmentation solutions.
The reasons why an individual may need a bone graft vary vastly. This may include osteoporosis, which creates obvious issues for implant placement. Osseointegration is critical for implant stability and a prerequisite for long-term clinical success,[ii] and the severe decrease in bone mass and alteration of the trabecular bone microstructure means osteoporosis is recognised to adversely affect it.[iii]
Type 1 diabetic patients,[iv] post-menopausal individuals (especially those that have experienced an early menopause),[v] and heavy smokers and drinkers[vi] are all at a greater risk of developing osteoporosis, and may be in need of a bone graft when receiving implant therapy as a result.
A myriad of other conditions could affect the structure of bone in the maxilla and mandible. Patients with severe periodontal disease could experience resorption of the jaw bone,[vii] and in turn require bone augmentation for a greater opportunity at implant success. Edentulism itself can be a cause for bone resorption,[viii] and those with injuries to the jaw, or previous major oral infections, may also need a bone graft if the site is sufficiently damaged.[ix]
Definitive clinical decisions can only be made after radiographic examinations of the treatment site, but awareness of the increased risks presented to the aforementioned patient groups may help clinicians identify those more likely to need a bone graft.
Effective tissue
The materials that may be used to achieve a successful outcome are expansive, but each will offer an advantage dependent on the present biological needs of the patient, and their personal preferences. The latter may be informed by their ethics or even generic inclinations to specific treatment methods.
For example, an autograft is a common treatment solution, where the graft tissue is obtained from an intraoral or extraoral site, before placement in the same patient. It’s the optimal choice for many complex augmentation procedures, and allows for a predictable placement of the appropriate bone quality and quantity.i Despite this, the technique does require a second surgical visit for the patient, with the potential for injury and scarring at the donor site.i
A patient could favour an allograft, where the donor is another person, or a xenograft, where the natural bone substitute is sourced from a genetically unrelated species.i The latter is typically bovine bone, which is used extensively in maxillary sinus lifting and implant procedures since they offer exceptional stability and low immunogenicity.i However, patients may protest the use of bone from another living being if they are vegan, or of a culture or faith that would be similarly against its use.[x]
A synthetic solution, or an alloplast, removes much of the ethical debate that surrounds bone grafting materials. This material can be brilliantly suited to a variety of treatment demands, with the reliability of a standardised product quality each time.[xi] Clinicians must be aware that they can lack regenerative abilities, which are often made up for with a simultaneously applied growth factor and/or membrane.x
Room for growth
Understanding the biomaterials available to you as a clinician, as well as the appropriate times to use them, is essential to the successful placement of a bone graft, and subsequent implant placement. Clinicians that wish to offer such treatments to these patients, as demand continues to increase, must in turn find a suitable source for training.
Dental professionals may turn to Straumann® for exceptional educational courses that provide patients with brilliant insights into the use of bone grafts and appropriate biomaterials, as well as a host of other aspects of implant dentistry. Straumann® brings together world-leading practitioners and opinion leaders to provide clinicians with the insights, techniques and vision to implement changes that transform their careers. Plus, courses are available for dental professionals of all experience levels, whether you are an implant dentistry novice, or experienced and eager to learn more.
With the need for a bone graft becoming exceedingly common in modern implant dentistry, it’s important for clinicians to consider increasing their knowledge in this area to help treat a greater number of patients. It may become an area of interest that rewards you in the years to come.
For more information, please visit https://www.straumanncourses.com
[i] Zhao, R., Yang, R., Cooper, P. R., Khurshid, Z., Shavandi, A., & Ratnayake, J. (2021). Bone grafts and substitutes in dentistry: A review of current trends and developments. Molecules, 26(10), 3007.
[ii] Parithimarkalaignan, S., & Padmanabhan, T. V. (2013). Osseointegration: an update. The Journal of Indian Prosthodontic Society, 13(1), 2-6.
[iii] Zhang, C., Zhang, T., Geng, T., Wang, X., Lin, K., & Wang, P. (2021). Dental implants loaded with bioactive agents promote osseointegration in osteoporosis: A review. Frontiers in Bioengineering and Biotechnology, 9, 591796.
[iv] Fallabel, C., Wood, K., (2023). Diabetes and Osteoporosis: How Are They Related? Healthline. (Online) Available at: https://www.healthline.com/health/diabetes-and-osteoporosis [Accessed January 2024]
[v] Leyland, S., (2021). What’s the menopause got to do with bone health? Royal Osteoporosis Society. (Online) Available at: https://theros.org.uk/blog/2021-03-22-what-s-the-menopause-got-to-do-with-bone-health/ [Accessed January 2024]
[vi] NHS, (2022). Osteoporosis, Causes. (Online) Available at: https://www.nhs.uk/conditions/osteoporosis/causes/ [Accessed January 2024]
[vii] Guiglia, R., Di-Fede, O., Lo-Russo, L., Sprini, D., Rini, G. B., & Campisi, G. (2013). Osteoporosis, jawbones and periodontal disease. Medicina oral, patología oral y cirugía bucal, 18(1), e93.
[viii] Chou, H. Y., Satpute, D., Müftü, A., Mukundan, S., & Müftü, S. (2015). Influence of mastication and edentulism on mandibular bone density. Computer methods in biomechanics and biomedical engineering, 18(3), 269-281.
[ix] Roland, J., Archibald, J., (2021). What You Need To Know About A Dental Bone Graft. Healthline. (Online) Available at: https://www.healthline.com/health/dental-bone-graft [Accessed February 2024]
[x] Bucchi, C., Del Fabbro, M., Arias, A., Fuentes, R., Mendes, J. M., Ordonneau, M., … & Manzanares-Céspedes, M. C. (2019). Multicenter study of patients’ preferences and concerns regarding the origin of bone grafts utilized in dentistry. Patient preference and adherence, 179-185.
[xi] Fukuba, S., Okada, M., Nohara, K., & Iwata, T. (2021). Alloplastic bone substitutes for periodontal and bone regeneration in dentistry: current status and prospects. Materials, 14(5), 1096.
