Bone Regeneration - Titsinides Savvas - Oral Medicine

The treatment of bone deficits has been the subject of many years of intensive research, with the first bibliographic references dating back to the 17th century.

With the advancement of medical science, the surgical repair of these deficits is considered imperative, for reasons of functionality, aesthetics and the psychological welfare of patients.

After the development of a deficit, the bone tissue has a regenerative reserve which, however, is not unlimited and depends on various factors such as the size of the deficit, the age and constitution of the person, as well as the type of bone. Based on these data, spontaneous, complete regeneration of bone tissue may not be possible and the empty space, in these cases, is replaced by fibrous connective tissue.

In this context, the contribution of grafting materials in various categories is crucial. Autografts are considered the gold standard because they have osteogenic properties with zero development of immune reactions or infectious diseases. However, they are available in limited quantities and show increased morbidity due to additional surgery at the donor site. At this point, application of various grafting materials - allografts, xenografts, alloplastics and growth factors - with various properties and characteristics - have been gradually developed in an effort to support the healing process without the disadvantages of autografts. In fact, recently, among other studies, an attempt is being made to focus scientific research in the field of synthetic / alloplastic materials as they are available in relative abundance, at an affordable cost, without risk of disease transmission. They also offer the possibility of using combination grafts and growth factors, expanding the dimensions of this scientific field.

In particular, in the field of Oral Surgery, the aforementioned materials are used mainly in the context of restoration of the volume of the alveolar ridge as well as in cases of elevation of the sinus cavity, in order to be able to subsequently restore with dental implants.

A. Regeneration of the alveolar ridge

In several cases where there is a need for implants in the jaw bone, a deficit in a horizontal or vertical plane is observed after a thorough radiological examination, which essentially prohibits the placement of an implant. In these cases it is possible to regenerate the bone of the alveolar ridge with the use of the aforementioned bone graft materials.

There are several methods of bone regeneration and their possible combinations and their description goes beyond the needs of this text. When it comes to choosing a particular method, the decision is made depending upon both the given conditions and the requirements of the patient.

B. Maxillary sinus lifting

In many cases of edentulous posterior areas of the upper jaw where the application of implants is required, following radiological examination, a lack of bone in the vertical plane for their placement is observed. In these cases, it is possible to increase the height of the jaw bone by placing a bone graft in the sinus cavity, a procedure that is very predictable in terms of its result and is a procedure that can be performed in the dental practice, without the need for hospitalization.

Frequently asked questions

How long does it take from the bone grafting to the final application of the implants?

The time it takes for the bone to regenerate can range from 4 - 5 months with the use of autologous graft to 8 - 10 months with the application of other types of graft materials.

Is there a possibility of any disease transmission with the use of grafting materials?

The possibility of transmitting a disease can be considered a possible scenario, even though it is only an infinitesimal probability, in the case of the use of materials taken from other people or animals. However, the reputable companies in the field apply strict sterilization techniques that eliminate these risks. In the case of synthetic materials there is no question of disease transmission.

Why do we raise the floor of the sinus cavity and do not seek vertical growth of the jaw bone?

The vertical growth of the jaw bone carries a higher probability of failure and higher morbidity compared to the elevation of the sinus cavity where the bone graft is boxed in a relatively isolated environment. In more severe cases, the sinus may need to be elevated, along with a vertical increase in the alveolar ridge, all of which are elements that are evaluated by the Doctor.

Are there any risks in raising the ground of the sinus cavity?

Undoubtedly, every surgery has a chance of failure and complications such as, for example, a possible graft infection. The detailed radiological examination, the strict observance of the surgical protocol by the surgeon and the postoperative instructions followed carefully by the patient will almost eliminate these scenarios.

Will I have severe pain or other symptoms after sinus surgery?

The operation does not exhibit strong postoperative symptoms. There is usually dull pain in the next 24 hours, which is relatively easily controlled with conventional painkillers. Another possible postoperative symptom is the feeling of nasal obstruction for a period of about 15 - 20 days, which gradually disappears and is treated with decongestants of the nasal mucosa.