Atrophy of the jaw bone tissue: options for restoring the dentition. Bone tissue of the tooth: structure and properties Destruction of the bone tissue of the tooth

It happens that, having lost a tooth, a person thinks about prosthetics only after a few years. Chooses a reliable modern technology- dental implantation. And he discovers that over the past time the bone tissue has “relaxed” - its volume and density have become insufficient for a full-fledged installation of the implant. About why there is a rarefaction of the jaw bone tissue and whether implantation without bone tissue augmentation is possible - read in our review.

What is jaw bone atrophy

Bone- a complex, living, constantly changing structure. As in any living tissue, it contains water - about 10%. On average, 25% of the composition of the bone is an organic, “living” component. These are proteins, mainly collagen, and cells that regulate the composition and structure of tissue. The remaining share is inorganic substances (mainly hydroxyapatites). These are the substances that give bone tissue strength and rigidity. The percentage may vary depending on whether we are talking about spongy or compact bone tissue:

  • spongy bone- porous and light, in it between the bone structures (trabeculae) there is a lot of free space where blood vessels pass. The structure is dominated by organic components.
  • Compact (cortical) bone- densely arranged and very strong. It is dominated by inorganic substances.

Living bone tissue is formed by bone cells: osteocytes and osteoclasts.

Osteocytes- These are the cells of the bone tissue that form it and regulate the process of calcification. They synthesize the protein structures of the bone, regulate mineralization - the concentration of calcium and phosphorus salts, thus maintaining a balance between the organic and inorganic components.

osteoclasts destroy "used out" or damaged bone structures.

In the normal state of a living organism, a balance between destruction and creation is continuously maintained - in order to create something new, you need to “clear the site”. But when, for some reason, the process of resorption (resorption) of bone tissue begins to predominate, bone tissue atrophy occurs.

Most often, bone loss develops after tooth extraction. In order to maintain a normal state, any organ must work, and non-working structures atrophy - the body does not have the opportunity to spend nutrients and energy to maintain a non-functioning organ in a healthy state. The bone tissue of the jaw is maintained in a “working” state by a load that is transmitted during chewing through the roots of the teeth. As soon as the tooth is removed, the load disappears. Gradually, the vessels that fed the removed tooth cease to function, which means that nutrition also ceases to flow into the jaw tissue. The jaw tissue in the area of ​​the extracted tooth begins to dissolve - to atrophy. According to a study by German scientists, after the loss of teeth, such changes occur in 95% of cases. Within 1 year after tooth loss, bone volume decreases by 25%. That is why dentists recommend putting an implant in its place as soon as possible after losing a tooth.

V clinical practice There are 4 degrees of atrophy:

  • insignificant;
  • moderate;
  • expressed;
  • rough.

With a slight decrease in bone density, implantation of teeth using optimally sized dental implants is possible. With severe atrophy, implantation is possible only after the reconstruction of the jaw.

Causes of loss of density and loss of jaw bone

Loss of a tooth is not the only reason for changes in bone structure. Such reasons may be:

  • inflammation of the gums and periodontium - structures that surround the teeth and ensure their stability;
  • cysts and inflammation in the area of ​​​​the roots of the teeth or maxillary sinuses;
  • jaw injuries;
  • osteoporosis;
  • congenital anatomical features.

Nevertheless, the main reasons for the development of atrophy of the jaw bone tissue are untimely prosthetics after tooth extraction.

Consequences of "relaxation" of bone tissue

Atrophy of the alveolar processes is not only a problem of a "local" scale. Gradually intensifying, the process causes irreversible changes:

  • The facial expression changes. Depending on where the defect is located, the upper or lower jaw is “shortened”, the lips sink in, and wrinkles form around them. The face acquires a characteristic "senile" appearance.
  • The teeth begin to move towards the "empty" space. The likelihood of loss of neighboring teeth also increases. Due to the fact that the location of the teeth changes, food remains are trapped between them: the development of caries is accelerated. Yes, and chewing itself becomes less effective, as a result - problems with the gastrointestinal tract.

And the main problem faced by patients of dental clinics is the impossibility of implanting teeth. According to Russian doctors, in 35% of patients it is impossible without reconstruction of the jaw bone tissue.

How to prevent the process of atrophy?

Since bone atrophy most often develops due to the extraction of a tooth (or several teeth), it is obvious that in order to prevent it, teeth should be restored as soon as possible. Several methods are traditionally used:

  • installation of a bridge structure;
  • installation of a removable prosthesis;
  • implantation.

The first two methods are relatively inexpensive. But, unfortunately, they do not restore the load on the bone in the place of the extracted teeth. The load falls on healthy teeth that fix the prosthesis, in the case of a removable bridge - on the gums. As a result, atrophy continues to develop. Often it negates the results of prosthetics - the gum "sags" after the bone tissue, a gap appears under the prosthesis. This is not only unaesthetic, but also dangerous - food debris accumulates in the resulting space, on which microorganisms that provoke inflammation actively multiply.

Dental implantation, unlike other methods of prosthetics, allows you to create a load directly on the bone tissue in the area of ​​the extracted tooth. Thus, the bone tissue continues to work in a normal mode, which means that all the necessary metabolic processes. This prevents thinning of the jaw bone.

Options for restoring the dentition with significant atrophy

But what to do if time is lost and the degree of bone tissue atrophy does not allow implantation of teeth? Today, there are two main methods to deal with this problem.

Restoration of the jaw bone tissue with subsequent implantation with delayed loading.

This is a classic technique that has stood the test of time. First, an operation is performed to increase the volume of bone tissue. There are different methods: sinus lift, splitting of the alveolar process, bone graft or artificial tissue infusion. Which of them will be optimal in this particular case, only the attending physician can decide. After the operation, it will take from several months to six months to restore bone structures, after which implants are implanted into the jaw, while without crowns - and again it takes about six months for their engraftment. Only after that, crowns are placed on the titanium base of the implants and the jaw finally receives a load.

Immediate Load Implantation

This relatively new technique has become possible thanks to special implants that are fixed not in the alveolar part of the jaw, but deeper, in its basal part, which consists mainly of a compact substance. Implants are selected based on the individual characteristics of the patient's jaw. They require a minimum time for healing - the prosthesis is installed already on the 3-5th day after the fixation of the implant itself. Due to the fact that the bone immediately receives a load, it maintains blood circulation, normal metabolism, which accelerates regeneration.


In order for an organ to maintain its structure and functions, it must work. This also applies to the bone tissue of the jaw. Loss of teeth leads to atrophy of the jaw bone. To prevent this process, it is necessary to replace it with a prosthesis as soon as possible after tooth extraction. Dental implantation is the closest natural way their restoration, allowing to preserve the volume and density of bone tissue.

How to choose a dental clinic?

About what to look for when planning dental implantation, Oleg Vladimirovich Filimonov, an implantologist at the Dental Implantation Center, tells:

“At least take an interest in the equipment on which the clinic operates, what materials it uses. For example, dentistry SMILE-AT-ONCE - official partner of well-known implant manufacturers: Nobel Biocare, Oneway Biomed, Straumann. Our website has detailed information about the tools, equipment, software and technologies we use. You can also find our licenses, certificates and awards there.

For the success of the treatment, it is important how long the clinic has existed, what is the experience of the doctors, whether they take advanced training courses. The specialists of our clinic have more than ten years of experience and regularly participate in scientific and practical conferences, training programs, and other educational events. Thus, all SMILE-AT-ONCE implantologists have valid certificates from the International Implant Foundation, which confirms their right to work in this field. The clinic is a member of the international community of implantologists (International Team for Implantology. ITI), which has existed for 30 years. We provide a full range of services for dental prosthetics using implants in seven days and give a lifetime warranty on implants, as well as offer a convenient treatment regimen for both patients from Moscow and other cities.”

License No. LO-77-01-013995 dated March 14, 2017. issued by the Department of Health of the city of Moscow

Editorial opinion

If you decide to install implants or other types of dental prosthetics, visit a periodontist first. If pathologies are identified, they will need to be eliminated. In addition, hygienic cleaning of periodontal pockets and teeth is necessary to eliminate plaque and tartar.

- This is a progressive pathological process, which is characterized by a decrease in the tissue of the jaw bones. It is characterized by a decrease in the size of the alveolar ridge and the jaw as a whole, an increase in the volume of the maxillary sinuses. Externally, atrophy is manifested by a decrease in the lower third of the face, accompanied by physiological, morphological, functional and aesthetic disorders. Diagnosed by clinical examination, radiography, CT, MRI of the jaws. Treatment consists in restoring the volume of the bone with surgical methods.

ICD-10

K08.2 Atrophy of the edentulous alveolar margin

General information

Jaw atrophy is a chronic irreversible process of bone tissue resorption. The pathological process affects people of any age after the loss of teeth (in 95% of cases - after surgical removal). It is more common in people over 50 years of age. The rate of bone loss is purely individual and varies in different parts of the jaw. During the year after the extraction of the tooth, there is a decrease in bone volume by 25%. With insufficient bone volume, it is impossible to restore lost teeth by prosthetics and installing implants. A person is faced with insufficient fixation and stabilization of prostheses, an aesthetic defect.

Causes of jaw bone atrophy

The main cause of bone resorption of the lower or upper jaw is tooth loss. At the same time, the start of atrophic processes and the stages of their course do not depend on the cause of tooth loss (trauma, dental disease, removal for medical reasons). There are a number of factors that contribute to the progression of the pathological process:

  • Chronic dental diseases. Chronic periodontitis, periostitis, periodontal disease, osteomyelitis, periradicular cysts and granulomas are accompanied by inflammatory processes in the tissues of the jaws and provoke resorption of the alveolar process. Fractures, bruises, mechanical damage to the teeth and alveolar process disrupt the processes of osteogenesis.
  • Congenital anatomical anomalies. Underdevelopment of the jaws is a component of some congenital malformations maxillofacial region: cleft lip, alveolar process and palate, dysostoses, Robin's syndrome. Some individuals are prone to atrophy due to a genetic predisposition.
  • Oncological diseases. Various tumors of the jaws can serve as the cause of bone resorption: cancer, odontogenic sarcoma, osteoma, chondroma, fibroma, hemangioma, ameloblastoma, odontoma, myxoma, ameloblastic fibroma, cementoma. Removal of neoplasms leads to a bone defect, which also causes atrophic changes.
  • Diseases of the body. In persons over 40-50 years old, osteoporosis is observed - a metabolic disorder in bone tissue. The disease is accompanied by a progressive loss of trace elements, the predominance of resorption processes, a violation of the structure of bones, a decrease in their density and mass. The main role in the development of pathology is played by metabolic disorders of calcium, phosphorus, vitamin D, as well as a lack of fluorine, magnesium, bromine, silicon and vitamins. Also, starting factors of atrophy can be diseases of the cardiovascular, endocrine, digestive, and nervous systems.

Pathogenesis

With a decrease or absence of a functional load on the jaw associated with tooth extraction, atrophic processes are triggered in the bones. During chewing, pressure is transmitted through the roots of the teeth to the jaw, which helps to maintain its performance and normal structure. Bone is formed and resorbed depending on the load. In its absence, the activity of osteoblasts decreases, and the process of resorption prevails over the process of osteogenesis. The first signs of atrophy appear as early as 3 weeks after tooth loss, in this area there is a decrease in the density of the trabecular bone network. In the first year of the absence of functional load, irreversible tissue changes occur.

Classification

In dentistry, horizontal resorption is distinguished (occurs along the width of the alveolar process) and vertical (occurs when the height of the ridge decreases). The process of bone loss can be uniform in the distribution of the jaw or uneven. Uneven atrophy of the jaws can be of several types:

  • 1 type- minor degree. The alveolar process of the jaw is well expressed, atrophic processes are minimal. Surgical interventions are not indicated. Prosthetics are needed to prevent the progression of bone resorption.
  • type 2 – average degree. Implant placement is not possible without jaw preparation. Orthopedic prostheses are poorly fixed in the oral cavity. Preliminary osteoplasty and bone augmentation are indicated.
  • 3 type- gross atrophy. The alveolar process is significantly atrophied. Orthopedic treatment is impossible without increasing the volume of bone tissue. To restore teeth and the function of the oral cavity, it is necessary to perform osteoreplacement operations.

Symptoms of jaw bone atrophy

The main sign of atrophy is a change in the appearance of the jaw. The alveolar ridge is significantly reduced in size. With complete adentia of both jaws, senile progeny is observed. Due to atrophy, the lower third of the face is shortened, its appearance. Lips sink into oral cavity, wrinkles form around the mouth. Malocclusion occurs, adjacent teeth tilt towards the missing ones. The phenomenon of Popov-Godon is observed - opposite teeth are put forward in place of the lost antagonist. There is a violation of the functions of chewing and speech, a deterioration in the aesthetics of the face. A person with jaw atrophy looks older than his passport age.

Complications

The main and most serious complication is the inability to carry out high-quality restoration of teeth. Due to the insufficient size of the alveolar process, it is impossible to carry out treatment by prosthetics or implantation, since there is insufficient fixation and stabilization of orthopedic structures. Prolonged progression of atrophy causes pain due to compression of the mental nerves. The result of a violation of chewing function are diseases of the digestive tract. The risk of pathological fractures of the jaw in areas of thinning increases.

Diagnostics

For the diagnosis of atrophy of the jaw bone tissue, both basic and additional methods research. In order to carry out the treatment correctly, it is necessary to determine the degree of atrophy and its exact localization in each part of the jaw using modern methods diagnostics. Are used the following ways pathology recognition:

  • External and intraoral examination. The appearance of the face, the clinical situation in the oral cavity, the number of missing teeth are visually assessed. By inspection and palpation, the shape and structure of the alveolar processes are determined, the type of resorption is established, and conclusions are drawn about the degree of dysfunction.
  • Radiography. To determine the type and severity of atrophy after the removal of a single tooth, an aiming image is used. Orthopantomography visualizes the upper and lower jaws, the condition of the teeth and roots, and the temporomandibular joints. There is an increase in the pneumatization of the maxillary sinus - an increase in its volume. Due to resorption, there is a decrease in the distance to the mandibular canal and nerve by 7-8 mm. According to the cephalogram in the lateral projection, the degree of resorption is monitored from the vestibular, occlusal and lingual sides of the alveolar process.
  • MRI and CT of jaws. They are the most accurate and detailed studies with a high degree of information content. On tomograms, all structures of the oral cavity are visualized, which allows specialists to correctly assess the severity of atrophy in each part of the jaw, correctly perform surgery and prosthetics.

Treatment of jaw bone atrophy

Increasing the volume of jaw bone is one of the most difficult tasks in dentistry. To eliminate atrophy, various methods of surgical interventions are used. Reconstruction is carried out using biological and artificial bone material. In each clinical situation, the dentist-surgeon individually selects the technique and type of material. The following treatments are used:

  • Splitting of the alveolar ridge. The operation of intercortical osteotomy is indicated in the presence of a thin or narrow alveolar ridge. It consists in a longitudinal osteotomy: special instruments are inserted between the cortical plates of the ridge and expand its alveolar part. The space between the plates is filled with osteoreplacement material. The method is distinguished by efficiency, ease of implementation, fast healing, good aesthetics.
  • Sandwich plastic. It is used to treat vertical atrophy, both in the lateral and anterior jaws. The operation consists in making one horizontal or two vertical cuts in the area between the chin holes and implanting the bone material. The advantage of the intervention is the predictability of the results, the absence of displacement or resorption of bone material.
  • Distraction osteogenesis. The method is indicated for congenital and acquired jaw defects. The purpose of the intervention is to activate the process of bone tissue formation. For this, an osteotomy is performed with the installation of a distractor, its activation and removal after bone augmentation.
  • Bone block transplantation. The operation involves increasing the volume of the jaw by bone grafting. The intervention is carried out for all types of atrophy. Autografts are introduced into the required area, fixed with screws or titanium mesh and covered with a protective membrane.
  • Sinus lift. Maxillary sinus floor plasty is indicated for atrophy of the upper jaw in the lateral area. The essence of the operation is to build up the bone of the required size for the installation of implants. Surgical intervention is very popular, effective and makes it possible to implement various implantation techniques.

Forecast and prevention

With timely treatment of bone atrophy, the prognosis is favorable: after osteoplasty, in most cases it is possible to carry out successful prosthetics. In the case of pathological fractures of the jaws, a long and difficult treatment. Prevention of atrophy of the jaw bone tissue consists in timely dental treatment, visiting the dentist 2 times a year for the purpose of examination. It is necessary to restore defects by the method of prosthetics and implantation within 6 months after the loss of teeth. Measures of general prevention include sanitation of the oral cavity, treatment chronic diseases teeth and the body as a whole, strengthening immune system, rejection of bad habits.

During eating, the bone tissue of the tooth experiences some load. If the teeth have fallen out, then the load is reduced, and the bone is reduced in size. When one tooth is lost, others have to work harder. This can lead to their rapid destruction.

The structure of the bone tissue of the tooth

The structure of bone tissue is different from that of other human cells. Osteoblasts and osteoclasts are special cells found in hard tissues. Osteoblasts produce collagen, which allows bone to continue to grow, while osteoclasts cause bone atrophy. Some cells continue to grow, others reduce the hard part. Joint work provokes a constant renewal of the bone tissue of the tooth.

Bone is made up of two parts:

  • cortical contains a large percentage of minerals;
  • spongy is more like bone marrow and consists of soft parts.

The lower and upper jaws differ from each other in structure. The lower one consists of a cortical layer that surrounds a small spongy layer. Such a structure is required in order for the lower jaw to withstand the load that falls on it. The upper jaw for the most part consists of a spongy layer and a small amount of hard tooth tissue.

Cause of atrophy

A decrease in bone tissue appears after the extraction of teeth. The more gaps in the dentition, the more pronounced the symptoms of atrophy:

  • gum size decreases in volume and height;
  • wrinkles around the mouth may occur;
  • sunken cheeks and lips;
  • drooping corners of the mouth;
  • asymmetry of the face;
  • the appearance of gaps between the remaining teeth.

Atrophy occurs due to several reasons:


The most common reason for bone loss is tooth extraction. The patient himself does not immediately understand that changes are taking place with the jaw. 3 months after the loss of a tooth, part of the gum begins to fail, and a year later, it is no longer possible to insert an implant in place of the gap without additional measures to restore the bone tissue of the tooth.

What causes bone destruction

Atrophy is not only an aesthetic problem; with this pathology, changes occur in the body and difficulties arise in other organs. Restoration of the dentition becomes a complex task and requires bone augmentation during dental implantation.

In the absence of teeth, food is crushed poorly, which eventually leads to a malfunction of the gastrointestinal tract.

The loss of a large number of teeth leads to a violation of diction and causes the appearance of deep wrinkles on the cheeks.

Non-carious lesions of the tooth tissue

One of the reasons for the appearance of bone tissue atrophy is damage for various reasons. This disease ranks second in the number of visits to the dentist after caries. It can affect one tooth or several and manifest itself with various symptoms.

Non-carious lesions of the tissues of the tooth can be congenital or acquired. One of the manifestations of damage can be erosion. Enamel is damaged, which leads to darkening, hypersensitivity and aesthetic problem. The disease can last for a long time and lead to loss of teeth. Sometimes the cause of the development of pathology is nutrition with a high content of acids and salts. Marinades and orange juice provoke the development of the disease. On the initial stage the disease is not diagnosed, because the loss of enamel luster is not very noticeable. But over time, the patient complains of pain. Prevention of erosion is an important component to prevent the development of damage to the hard tissues of the teeth and atrophy.

Another common cause of damage to the dentition is increased sensitivity of the teeth. Under the influence of temperature, strong pain, which subsides quickly. The disease can disturb one tooth or affect several. If left untreated, there is a risk of surgery or removal. To replenish the missing minerals in the tissues of the tooth, vitamin-mineral complexes are taken.

Bone restoration

The restoration of bone tissue has become possible thanks to the development of medicine. The doctor determines whether restoration is required before the implantation of the tooth. As a rule, this is necessary. Building up the bone tissue of the tooth takes from 6 to 8 months.

Bone restoration is necessary in the following cases:

  • absence of a tooth;
  • periodontal disease;
  • removal of the old implant;
  • jaw injury;
  • removal of the cyst in the cavity.

When a tooth is removed, especially during a complex procedure, inflammation may develop, which leads to the rapid erosion of bone tissue. The longer a tooth is not replaced, the more atrophy will appear and the more difficult it is to place a new implant.

In periodontal disease, the bone tissue at the base of the tooth is destroyed. If the disease is not stopped in time, this leads to the loss of the molar, and the restoration will require an increase in the jaw bone.

Removal of an artificial tooth is possible when using poor-quality material or poor-quality work. In such cases, the implant may break and damage the jaw. Therefore, restoration of soft and hard tissues will be required.

If a cyst or tumor was removed, then the bone tissue could be affected. Surgery will then be required to repair the hard parts.

In case of a jaw injury, in particular with a fracture, the restoration of some parts is required for further prosthetics.

Recovery methods

To build up the bone part of the tooth, several methods are used, the use of which depends on the degree of atrophy.

Drug is used at the initial stage of atrophy to slow down the process.

The most common method is operational. Recovery occurs in full with minimal risk side effects. How to deal with atrophy is up to the doctor, but the method will differ depending on which jaw is being operated on.

Restoration work is carried out under local anesthesia. Ultrasound is used to minimize damage and reduce recovery time. A drug is injected into the bone that stimulates cells to regenerate, and within 8 months the bone tissue is completely restored.

Sinus lift for recovery

The sinus lift procedure is designed to increase bone tissue by lifting the maxillary sinuses. It is used provided that the patient has no pathologies and allergic reactions.

If the patient has a history of chronic runny nose, sinusitis or multiple septa, then the operation will not be performed.

The procedure allows you to increase the missing volume of bone tissue, but there remains a risk of a chronic runny nose or inflammation in the future.

Protection of the jaw against atrophy

Atrophy of the bone tissue of the tooth is treated surgically, but this can be avoided if the destruction of hard tissue is not allowed.

To do this, it is necessary to restore lost teeth in time and prevent the loss of existing ones. Implants are much better than other methods, because they have a root and create a load on hard tissues. Removable dentures do not give a full load on the lower jaw, and over time, atrophy of the hard tissues of the teeth will occur. Treatment occurs similarly with a significant loss of the bone of the jaw. If hard tissues sag gradually, then correction of prostheses without treatment of atrophy will be required.

In the treatment of atrophy, the choice of treatment method depends on the desire of the patient. What does he want to achieve? Complete restoration of bone tissue and its function or to create external beauty?

To prevent atrophy and other diseases of the oral cavity, it is necessary to visit the dentist twice a year.

From this article you will learn:

Bone grafting during dental implantation (synonymous with bone augmentation) is a surgical operation that allows you to increase the volume of the bone at the site of installation of one or more. The need to increase the volume of the bone is dictated by the fact that after the removal of teeth in a person - in the area of ​​missing teeth, the bone tissue undergoes gradual atrophy, which leads to a decrease in the width and height of the alveolar process of the upper and (or) mandible.

Bone tissue growth during dental implantation is necessary not only for the normal functioning of the implant (in terms of chewing load), but also for aesthetic reasons. The fact is that too thin bone walls around the implant are always subject to resorption (resorption) - as a result, the level of the gums lowers and the metal neck of the implant is exposed. More than 90% of all negative feedback from patients after implantation refers specifically to the unsatisfactory appearance of the gums around the implant neck.

Scheme of bone grafting -

Optimal bone thickness around the implant –

The most important points (according to Fig. 1) -

1) Firstly- the thickness of the vestibular bone wall (i.e., the one located on the side of the lip / cheek) - should be at least 2.0 mm, and very well - 2.5 mm. If the front surface of the implant is covered by a bone less than 2 mm thick, then this means 100% bone resorption around the implant neck, accompanied by a lowering of the gum level and exposure of the dental implant neck. The implant in this case will still carry a functional load, however, if it is in the smile zone, the appearance of the gums around the implant will eventually become aesthetically unacceptable.

2) Secondly- the thickness of the bone wall between the implant and the root of the adjacent tooth should preferably be at least 2.5 mm. If this distance is smaller (for example, 1.5-2.0 mm), then the following problem arises. The fact is that even in normal conditions, there is always a slight bone resorption around the neck of the implant. If the bone partition between the implant and the tooth root is too small, bone resorption will occur not only around the implant, but also at the root of the adjacent tooth. This means a lowering of the gingival level and the absence of an interdental gingival papilla (i.e., there will definitely be poor aesthetics).

3) Thirdly– The thickness of the bone wall between two adjacent implants should ideally be 3.0 mm. If less, then, as in the previous case, this means a significant resorption of the bone septa between the implants, and as a result of this process - the lowering of the gums in this area, the absence of the gingival papilla, the exposure of the implant (i.e. poor aesthetics).

Causes of bone deficiency

1) The main reason for the decrease in the volume of bone tissue is the regular atrophy (resorption) of the bone, which occurs in the area of ​​the extracted teeth. This happens because the bone loses its support in seeing the root of the tooth, and also due to the fact that in the absence of the root of the tooth, chewing pressure ceases to be exerted on the bone tissue. As a result, there is a decrease in the volume of the bone, which can occur both in height and in width of the alveolar process of the jaw.

2) The second reason is traumatic dental surgeons. Usually, during the removal, the surgeon absolutely does not think about the safety of the bone walls of the alveoli around the tooth, biting them with forceps. If you are planning an extraction with subsequent implantation of a tooth, then it is best to carry out such an extraction with an implant surgeon who will try to preserve the bone tissue as much as possible.

There are 3 types of bone resorption –

  • horizontal resorption (Fig. 2), when there is a decrease in the width of the alveolar process,
  • vertical resorption (Fig. 3), i.e. when there is a decrease in the height of the alveolar process,
  • + combined form.

According to the type of resorption in a particular patient, a bone grafting technique is selected, aimed at increasing the width and / or height of the alveolar process of the jaw.

Bone grafting for dental implants: reviews

There are many different methods of bone grafting, but they can be conditionally divided into 2 large groups. Firstly, horizontal bone augmentation techniques aimed at expanding the narrow alveolar process. Secondly, vertical bone augmentation techniques aimed at increasing the height of the ridge of the alveolar process.

Most commonly used techniques –

  • splitting of the alveolar process,
  • bone block transplantation,
  • Guided Bone Regeneration (GBR)
  • sinus lifting method (used with a lack of bone height in the lateral sections of the upper jaw).

All these operations are performed under local anesthesia, if necessary (the fear of the patient) intravenous sedation can be performed. The duration of the operation can be from 1 to 2 hours, which will depend on the technique used, the volume and complexity of the operation. The stitches are removed on the 10th day.

Important : All methods have their pros and cons... Histological studies showed that after bone augmentation by different methods, there is a completely different structure newly formed bone tissue, which can lead to subsequent resorption of the already newly formed bone. In addition, a lot depends on the nature of the implanted bone material.

1. Splitting of the alveolar process -

Used for horizontal bone resorption to increase the thickness of the alveolar process. It can be performed both on the lower and on the upper jaw. It must be said that this is the most effective method of expanding the alveolar process today, which, moreover, has a low cost (it does not require expensive bone materials and membranes). There are several varieties of such splitting, but we will especially focus on the “Split-Control” technique, which allows you to simultaneously carry out both expansion and installation of implants.

The content of the "Split-Control" methodology(Fig.5-10) –
after detachment of the mucoperiosteal flaps (gums), a cut is made in the center of the crest of the alveolar process with a cutter or other special instruments to the height of the future implant (Fig. 6). Next, a hole for the implant(s) is marked with a pilot drill, and spreaders are screwed into the prepared holes (Fig. 7). Using different sizes of spreaders from smaller to larger, you can increase the width of the ridge and immediately install the implant.

There is always a gap on the sides of the implant, which is filled with bone material, which, if necessary, can be applied in excess and outside the alveolar process, covering it all with a special resorbable membrane (Fig. 9). After that, the wound is sutured, and we wait for the osseointegration of the implant within 3-4 months.

Bone grafting of the lower jaw (splitting method) –

Advantages of the technique –

  • Firstly- due to the splitting of the ridge, we get a bone defect that has bone walls on all sides (except on top). Thanks to this, fast and high-quality osteogenesis (the formation of a new bone) occurs, because spongy bone in the depths of the alveolar process is rich in blood vessels, osteoblasts, mesenchymal cells, growth factors ...

    By the way, why it is much worse to increase the width of the bone not due to splitting (from inside the alveolar process), but to do this due to external attachment of bone blocks or bone chips outside the cortical plasty of the alveolar process (site). The fact is that the outer cortical layer of the bone is very dense and there are practically no vessels in it. Accordingly, the transplanted bone material will take a very long time to grow into vessels, bone formation will proceed more slowly, and there will be a greater risk of failure and complications of such bone grafting.

  • Secondly- there is no need for expensive bone materials and membranes, again due to the fact that this is a three-wall defect inside the alveolar process, and not outside it. There are enough inexpensive materials, for example, bone material "Osteodent-K" and the membrane "Osteodent-Barrier". But if you are principled, then you can use expensive materials like "Bio-Oss".
  • Thirdly– installation of implants with this technique in most cases is possible immediately. If the implants are installed later, then only 3-4 months will have to pass between the operations, which is much less compared to other bone grafting methods.

Splitting of the alveolar process: animation and video of the operation

Important : There are several types of splitting methods. With “Split-Control”, only a cut is made along the crest of the alveolar process + a pair of vertical cuts to the thickness of the cortical plate. But there is a variation of this method, where an additional horizontal cut is made at the level of the tops of future implants, which leads to the complete detachment of the bone block (vestibular cortical plate).

Then this block is fixed with screws, which often break it. Implants with this modification of the technique are not installed immediately, but after 3-4 months. In addition, it is very traumatic and more risk of complications. This type of technique should only be used on the thinnest alveolar process (2 mm), but some doctors use it even in cases where this is not necessary.

2. Bone block transplantation -

This method can be used both to increase the width of the alveolar process and its height. This technique predominantly uses an autogenous bone block (this means that the bone block is taken from the patient himself in other parts of the jaws). Block sampling can be carried out in the region of the tubercle or zygomatic-alveolar ridge of the upper jaw, or in the region of the branch or chin area of ​​the lower jaw. Bone blocks of allogeneic and xenogenic origin (bovine bone) are used less often, which is associated with their much lower efficiency.

An example of a bone block transplant operation –
On photos 11-16 you can see an example of how bone grafting of the upper jaw (in the area of ​​the central incisor) is performed using two bone blocks. Please note that 2 blocks were used because in this case it was necessary to increase both the width and height of the alveolar process in the area of ​​the extracted tooth.

Bone blocks are first screwed to the bone using special titanium micro-screws (Fig. 12). The block can be additionally covered with bone chips, after which the blocks and the surrounding bone tissue must be closed with a collagen membrane (exactly the same as those used for guided bone regeneration). The membrane is fixed to the bone with the help of special metal pins (Fig. 14), and then the mucous membrane over the operation site is tightly sutured.

Bone block transplantation: animation and video of the operation

Advantages of this method –
this is an excellent method for increasing bone volume with predictable results. The gold standard for this method is the use of an allograft (a bone block taken from the patient himself). Moreover, it is very important that the transplanted graft be "cortical-spongy", i.e. had not only a cortical plate, but also spongy bone tissue. In this case, a predictable and positive result of bone block transplantation can be obtained.

Cons of this method –

  • An additional operation to take the bone block is required.
  • Secondly, with this technique, the possibility of simultaneous installation of implants is most often excluded, because. this greatly increases the risk of rejection of both the implant and the bone block itself.
  • Thirdly, such bone blocks require a longer engraftment, i.e. after such an operation, it will be necessary to wait about 6-8 months before starting the installation of implants at all. This is due to the fact that the bone block is screwed on the outside of the jaw. The superficial cortical layer of the jaw bone has very few vessels, and therefore the germination of vessels into the transplanted bone block is very slow.
  • Fourthly - again due to the slow germination of the bone block by the vessels (during the subsequent installation of the implant at the second stage) - sometimes the bone block can be detached from the jaw due to its insufficient integration with the jaw bone tissue.

3. Guided tissue regeneration (GTR) -

This method can also be used to increase the width of the alveolar process, as well as its height. In addition, if the lack of bone tissue volume is not critical, then simultaneously with bone grafting simultaneous installation of implants is also possible. However, the method also has its drawbacks, which we will discuss below.

Guided tissue regeneration (synonymous with guided bone regeneration) involves the use of two components: firstly, implanted bone material, and secondly, a special barrier membrane, the use of which will isolate the bone defect from adverse factors.

Guided bone regeneration: examples of operations

1) Clinical case №1 –
 Photo 17 (in the area of ​​the planned implantation) shows a significant bone defect, which will be filled using a bioresorbable membrane and Bio-Oss bone material. In photos 21-22, taken 5 months after bone grafting, you can see the installation of the implant in this area…

2) Clinical case No. 2 –
 the use of guided bone regeneration techniques simultaneously with the installation of implants. The inert material "Bio-Oss" and the resorbable membrane "Bio-Gaid" were used as materials ...

Barrier Membrane Importance –
The barrier membrane performs the following functions: it allows to give the desired shape and volume to the augmented bone tissue, protects the transplanted bone from resorption by its osteoclast cells (located in the periosteum), prevents the soft tissues of the gums from mechanical impact on the transplanted bone material and its deformation ...

Exists different types membranes, resorbable (Bio-Gaid), non-resorbable (Gore-tex or mesh titanium membranes). The former dissolve on their own over time and do not need to be removed, but they hold their shape much worse compared to mesh titanium membranes or titanium-reinforced membranes. All these membranes are expensive, but the use of cheap membranes (such as Osteoplast) is not suitable for this technique.

Choice of bone material –
there are many different materials: based on synthetic hydroxyapatite, biopolymers, tricalcium phosphate, bioglass, based on bovine bone, etc. Below we will focus on the most effective types bone materials (in descending order of their effectiveness).

  • Use of bone autograft –
    an autograft should be understood as bone material that is taken from the patient himself in other parts of the jaws (for example, in the form of bone chips or a bone block). There is only one minus here - the need for an additional small intervention for the collection of bone material.
  • Combination autograft + xenograft –
    in a ratio of 1:1, bone chips (taken from the patient himself) are mixed with xenogenic material, i.e. based on bovine bone. Such a high-quality and effective material as "Bio-Oss" can serve as an example of it. This is a very effective combination for increasing bone volume.
  • Allograft use –
    this type of bone material is also very effective, but is used much less frequently. The fact is that the source of bone material in this case is the cadaveric material (of other people). These materials are purchased from a special tissue bank, all materials are carefully processed and completely safe, but for psychological reasons they are used less frequently.
  • Use of pure xenograft –
    "Bio-Oss" material (based on bovine bone) can be used without mixing it with the patient's own bone chips, but then the efficiency of bone growth will be lower.

Guided bone regeneration with immediate implantation: operation video

  • Video 1 - using Bio-gaid resorbable membrane,
  • video 2 - using a titanium mesh membrane.

Important : It should be noted that this method is not always effective enough. The fact is that the bone material is “planted” outside the cortical plate of the jaw (a very dense surface layer of the bone). The newly formed bone differs in structure from the own jaw bone, does not have its own cortical plate outside, and therefore has a tendency to subsequent partial resorption.

Therefore, it is necessary to carry out bone augmentation by this method “with a margin” for the planned degree of future resorption, which will be the more pronounced, the thinner the gum biotype (gingival thickness) is. This is due to the fact that the surface layers of the bone will receive less oxygen and nutrients due to their lower blood supply.

How much does a jaw bone augmentation cost for a dental implant in 2020? Bone tissue augmentation for implantation - the cost will differ depending on the type of technique and volume of the operation (in the area of ​​how many teeth it is performed), as well as on the type and volume of bone material and membrane used.

Bone augmentation during dental implantation: price 2020

  • Splitting of the alveolar process –
    in the area of ​​​​1-2 teeth, it will cost about 15,000 rubles + the cost of materials, which in this case can be used inexpensively and meet the materials in the amount of 3-5 thousand rubles.
  • Bone harvesting and grafting surgery –
    will cost about 36,000 rubles (this cost includes both the fence and transplantation of the bone block, but does not include the cost of additional materials, for example, a membrane, the cost of which will be about 13,000 rubles more).
  • Guided tissue regeneration technique –
    the NTR technique in the area of ​​​​1-3 teeth will cost about 25,000 rubles (excluding the cost of the membrane and bone material). If we take high-quality European materials, then the cost of the Bio-Guide membrane is about 13,000 rubles, and the cost of Bio-Oss bone material (0.5 g package) is about 12,000 rubles.

    If this technique is carried out simultaneously with the installation of the implant, then the price of the service (excluding the cost of bone material and membrane) will be another 5,000 to 10,000 rubles - in addition to. In addition, the patient will bear the cost of bone material and membrane (prices are indicated above).

  • Sinus lift surgery –
    it is carried out in the lateral sections of the upper jaw and consists in raising the bottom of the maxillary sinus. The cost of a closed one starts from 10,000 rubles, an open one - from 25,000 rubles, but keep in mind that this price does not include Additional materials(membrane, implanted bone material).

Bone grafting: complications

Bone grafting during implantation of teeth - reviews will depend on the precise performance of the surgical technique by the surgeon. Any deviation from the technology of the operation with a high probability leads to failure and even rejection of the transplanted bone. In addition, in most cases, a lot depends on the quality of the bone material used, the membrane.

With both methods of operation, it is possible to expose the membrane through the suture line, which in many cases leads to purulent inflammation of the wound. The use of the bone block grafting technique with insufficient vascularization rate can lead to sequestration (rejection) of parts of the bone block or its entirety. Both with purulent inflammation and sequestration, it will be necessary to remove all materials from under the mucous membrane (both the membrane and the bone material).

In addition, when using bone blocks, there is a loss of the volume of the bone block in the process of integrating it into tissues - sometimes up to 50%, which can be critical and require a second operation. It is also possible to tear off the accustomed bone block (during the screwing of the implant at the second stage), which is associated with insufficient integration of the block into the jaw's own bone tissue.

Important for smokers:
 bone grafting of the jaws (as well as the installation of implants) is a relative contraindication in smoking patients, especially heavy smokers. The fact is that nicotine leads to a sharp narrowing of the lumen of blood capillaries in the tissues of the oral cavity, which sharply reduces blood flow to the bone graft or implant. The lack of blood flow leads to insufficient supply of oxygen and nutrients to the tissues, which prevents both bone formation and simple osseointegration of the implant.

If you want to have bone augmentation for dental implants without complications, then you must stop smoking at least 2 weeks before bone grafting and for 4 months after surgery. If implants are installed not simultaneously with bone grafting, but at the second stage, you will have to stop smoking again at the same time. If you are unable to quit smoking, then you should consider dental implants that are designed specifically for smokers and do not require bone augmentation.

Alternatives to bone grafting -

In some cases, the use of small-diameter implants makes it possible to completely avoid or significantly reduce the volume of bone grafting. The fact is that for implants of small diameter of bone tissue, much less is required. They exist with a diameter of only 2.9 mm, and are made of the unique Roxolid material (it is an alloy of titanium and zirconium). This material is much stronger than titanium and, moreover, it has significantly better osseointegration compared to conventional titanium implants.

Thanks to these characteristics, the implant remains, firstly, mechanically strong, and secondly, it is able to carry a significantly larger amount of masticatory load (compared to larger-diameter implants made of traditional titanium). The only disadvantage of the implants of this Swiss manufacturer is their higher price.

But with insufficient bone height (in situations where bone grafting in a patient is considered undesirable, for example, for medical reasons) - you can use another type of Strauman implant, which is called "Standard Plus Short". This type of implant is only 4.0 mm long, which is the shortest internally connected screw implant available on the market. It is used specifically for insufficient bone height.

How can you avoid bone grafting altogether?

If there is a lack of width or height of the bone and is used - in this case, bone grafting is mandatory. However, there are 2 methods that allow not to build up bone tissue for implantation. The first of them is the best alternative, including for smokers.

1) Firstly is a method. A special type of implants is used here, which is fixed not in the soft spongy bone of the alveolar processes (as in the classical implantation technique), but in a deeper basal layer of bone tissue, which is practically not subject to atrophy. This technique can be used both in the partial absence of teeth, and for fixed prosthetics of a completely edentulous jaw.

2) Secondly- There is a technique. It is used exclusively for fixed prosthetics of a completely edentulous jaw, and in almost 100% of cases it avoids the need for bone grafting. This becomes possible due to the fact that the implants here are installed at different angles to each other, which, accordingly, requires a smaller bone height.

With "All-on-4" you get a fixed horseshoe bridge of 12-14 teeth, which will be fixed on just 4 or 6 implants - on the day of surgery. The technique was developed by Nobel Biocare (Switzerland), a world-famous manufacturer of implants. We hope that our article on the topic: We hope that our article on the topic: Bone grafting for dental implantation prices, reviews - turned out to be useful to you!

Sources:

1. Add. professional ,
2. Personal experience dental surgeon (implantologist),
3. American Academy of Implant Dentistry (AAID),
4. National Library of Medicine (USA),
5. "Bone grafting before dental implantation" (Kulakov A.A.),
6. "Bone grafting in dentistry" (Pankratov, Lekishvili).

Considering the issue of well-being of a person as a whole, one cannot remain silent about health and restoration of bone tissue. And it is about this, about the restoration of bone tissue, that will be discussed in this article. What is it?

The main thing is to supply our body with the nutrients it needs. For health and bone tissue restoration at least 20 different trace elements are required. But when they are not enough, then, not immediately, of course, but over time, a disease of bone porosity develops

A little information

But not only the lack of Calcium and other trace elements causes such a result, as many people think. The value has a number of factors that are associated with a person's life and for a number of years.

It is no secret that over a period of seven to ten years, bone tissue is completely replaced in people. For example, if you are 28 years old, then your skeleton composition has already been updated 3 times. Imagine how many times bones are replaced if you are already 60? That is, there is a natural restoration of bone tissue.

But then the question involuntarily arises, why do not new teeth form, because this is also bone tissue? Nature conceived everything very cunningly - our skeleton does not collapse, because there is fatty and muscle tissue. This is a plus, but there is also a minus. Monitor and control status and process bone tissue restoration with its powerful environment is almost impossible.

But just the health of the teeth screams with pain as soon as a problem arises. And involuntarily, a person adheres to the rules for caring for his teeth and mouth because of the fear of pain, loss of a tooth, going to the dentist.

But with bone tissue, we do not have such caution. Here you just need to know what means can help maintain bone strength, due to what happens bone tissue restoration and use them naturally.

The fact that our skeleton is periodically updated does not mean at all that it becomes stronger and better. You can say so, though new, but not equivalent. Unfortunately, bone density and strength decreases with age.

For bones, this means that they become lighter and less strong. With age, in general, everything in us changes not for the better, and the bones also age.

Our actions.

We should not put up with such a picture. We must try to help ourselves maintain our health and quality of life. We can identify several areas of our action that help restoration of bone tissue. Let's list them:

- Physical activity.

The main condition is that it must be high quality supplements! Then you can easily strengthen your skeletal system and in general solve a lot of problems to ensure health, prevent it and get out of painful conditions!