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What to expect during bone grafting

If you have severe gum disease known as periodontitis, you may have lost some of the bone that holds your teeth in place. Your dentist or a gum disease specialist (periodontist) may suggest a bone graft. Bone grafts can help grow new bone to replace the bone destroyed by periodontitis.

Gum disease and bone loss

Many people know that untreated gum disease leads to tooth and gum tissue loss, but did you know it can also cause bone loss in your jaw? Periodontitis is a chronic bacterial infection that affects the gums and the bone that supports the teeth. Poor oral hygiene allows bacteria living in the dental plaque to thrive, causing inflammation and tenderness in gums. During this first stage of gum disease called gingivitis, gums swell slightly and bleed easily.

The most severe form of gum disease is periodontitis. It develops when bacteria and the toxins produced by the plaque bacteria infect the gums, invade below the gum line and infect tissue beneath the teeth. At this late stage, the infection breaks down the bone and tissues that keep teeth in place. Left untreated, the destruction continues until the teeth become loose from lack of support and eventually fall out. Periodontal disease is the most common cause for tooth loss in adults.  However, periodontal surgery procedures are available, including bone grafts, that can help reverse some of the damage caused by periodontal disease.

Symptoms of Gum Disease:

  • Persistent bad breath
  • Swollen or bleeding gums
  • Loose teeth
  • Sensitive teeth
  • Mouth pain when chewing

Bone grafts and gum disease

During periodontal surgery the periodontist may need to place a bone graft to help regenerate lost tooth supporting bone. During the procedure the periodontist folds back part of the gum and cleans out any infected gum tissue, bacteria covered calculus and rough tooth surfaces that can make gum disease worse. Then bone graft material is placed, which works with the body to help build new bone. Bone grafts can repair damage from gum disease and may boost the chances of keeping your teeth.

When tooth loss has already occurred, a metal post can be inserted into the jawbone to act as an artificial tooth root. This requires strong and ample bone to form a stable base. If there is not enough bone is present a bone graft is needed before you can get an implant. In bone grafting, a piece of bone is removed from another part of your jaw or your body, such as your hip, and transplanted to your jawbone. Frequently, commercially available artificial bone is also used.  It will take several months for the transplanted bone to be ready for a dental implant. New bone growth will eventually replace the graft material. Sometimes you may need only minor bone grafting which can be done at the same time as the implant placement surgery.

Types of bone grafts

Types of bone grafts differ depending on the material used:

  • Autograft: a bone graft using your own bone, usually sourced from the hip bone or back of the jaw.
  • Allograft: a bone graft using bone sourced from a human donor.
  • Xenograft: a bone graft using bone from an animal, usually a cow.
  • Alloplast: a bone graft using synthetic material containing calcium, phosphorous and hydroxylapatite.

Ask your dentist to explain the advantages and disadvantages of the different materials and grafting procedures.

Tissue regeneration and gum disease

Besides the bone graft itself, membranes (mesh filters), or tissue-stimulating growth factor proteins may also be used to encourage your body's natural ability to regenerate bone and tissue.  For example, in addition to the bone graft, your dentist may suggest a procedure called guided tissue regeneration (GTR). In GTR, after the bone graft is placed, the periodontist inserts a tiny piece of mesh between the gum and bone. This mesh prevents gums from growing into the area where the new bone should grow. Newer clinical techniques and material options continue to be developed and studied for periodontal defect repair/regeneration. Various bone replacement graft materials, barrier membranes, growth factors and combinations of these have been used.

Grafting and GTR are some of the advanced methods that periodontists can use to help fight gum disease. Scientists are still looking at how these new discoveries can help people keep their teeth longer.

Preventing bone loss from gum disease

The best way to avoid bone loss is to prevent gum disease in the first place.

  • Gently brush teeth twice a day with a fluoride toothpaste, paying special attention to the gumlines.
  • Floss between teeth daily.
  • See your dentist for regular checkups.

If you have periodontal disease, a combination of good daily oral hygiene, a sound diet and regular periodontal maintenance care with your dentist or periodontist will increase the chances of keeping your natural teeth for a lifetime.

 

Sources:

Periodontal (Gum) Disease National Institute of Dental and Craniofacial Research, National Institutes of Health - 2018 https://www.nidcr.nih.gov/research/data-statistics/periodontal-disease  Accessed July 2018

“Periodontal Treatment and Procedures.” American Academy of Periodontology. https://www.perio.org/consumer/periodontal-treatments-and-procedures  Accessed July 2018“Regenerative Procedures.” American Academy of Periodontology. https://www.perio.org/consumer/gum-disease-regenerative-procedure  Accessed July 2018

Natural graft tissues and synthetic biomaterials for periodontal and alveolar bone reconstructive applications: a review. Sheikh Z, Hamdan N, Ikeda Y, et.al.  Biomater Res. 2017 Jun 5;21:9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460509/  Accessed July 2018

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