Implants for bone atrophy
Bone loss and reconstruction options at UNIDENT UNION®
Bone loss can be caused by many different factors, e.g. past trauma, gingivitis and bone inflammation due to the presence of bacterial plaque (periodontitis). Most often, however, after tooth extraction, there is a reduction in the height and width of the jawbone due to the lack of mechanical load. Meanwhile, an adequate amount of bone tissue is necessary to ensure the long-term stability of implants.
Therefore, difficult cases include those situations in which there is not sufficient quantity or quantity and quality of bone to be able to place an implant and reconstruct the missing tooth on it.
In such situations, additional surgical techniques should be used prior to implantation.These are now widely used in the best implant centres around the world.
W UNIDENT UNION® We perform all surgical procedures to prepare the patient's skeletal system for the placement of implants. The techniques we include in the treatment are:
- Guided Bone Regeneration (GBR)
- Alveolar clefting (Ridge Splitting)
- Sinus lift
- Autogenous bone grafts (bone blocks)
- Piezosurgery techniques
Ref. 1 - Guided Bone Regeneration (GBR)
In the past, implants were only placed in the jawbone where there was adequate size and density, which limited the indications for their use. We now plan to place implants where they are most desirable from a prosthetic point of view. This has been made possible, among other things, by bone reconstruction procedures.
At the UNIDENT UNION clinic® we use quality-confirmed, authorised Bio-Oss and Bio-Gide products. Statistically, 41% of implant insertion procedures require an additional contribution from guided bone regeneration (GBR).
The decision to extend the procedure must sometimes already be taken by the doctor during the operation itself. This is because it is only during the surgery that the need for alveolar reconstruction can be seen or its widening in a specific area. Even a CT scan only shows an image of the transverse dimension of the bone. The generation of new tissue and the thickening of the bone layer is achieved by the GBR procedure. It is essential for the surgeon to prevent the movement of epithelial cells and cells arising from connective tissue towards the newly formed bone tissue. Physical barriers in the form of special membranes are used for this purpose.
The use of biomaterials - bone substitutes combined with a membrane - makes it possible to achieve complete regeneration of the damaged bone around the implant or to widen the missing own bone in the desired direction.
After a period of 6-9 months, the particles of the biomaterial used fuse with the bone and provide the basis for the body to create a new bone structure, and then gradually decompose. The membrane is absorbed by the body once it has fulfilled its role. Once the process of guided tissue regeneration is complete, the bone is permanently altered and subsequent radiological images are often indistinguishable from your own bone!
How can the bone be rebuilt?
Human bone tissue has the capacity to regenerate, in other words to rebuild missing bone. However, in most cases, the body needs help. The natural products Bio-Oss and Bio-Gide effectively support the body's own processes during bone reconstruction.
Newly formed bone needs a scaffold that behaves like a structural skeleton. The bone substitute material Bio-Oss, with its highly porous structure, meets this requirement perfectly. The Bio-Gide membrane is placed on the surface of the healing bone and serves as a protective barrier to prevent fast-growing soft tissue from growing into the space that should be occupied by slow-growing bone. In addition, Bio-Gide promotes proper wound healing.
WHAT ARE BIO-OSS AND BIO-GIDE?
Bio-Oss and Bio-Gide are natural products. Due to their high similarity to human tissue, they ideally stimulate the bone formation processes of tissue healing taking place in the human body. During the healing process, they integrate into the tissues and then gradually decompose during the metabolic processes in the human body. In the case of Bio-Oss, this process can take several years, while the Bio-Gide membrane is completely broken down within a few months.
Bio-Oss is a zoonotic product. During the production process, the organic elements are removed, so that only the hard part of the bone consisting of calcium compounds remains.
Bio-Gide jest membrane produced from zoonotic collagen. In the human body, collagen protein is the main component of skin and connective tissue. The natural protein structure of Bio-Gide accelerates wound healing processes and, by acting as a protective barrier, enables optimal bone regeneration.
HOW IS THE TREATMENT CARRIED OUT?
The bone reconstruction procedure takes place in one or two stages.
- One-step- bone reconstruction and implant insertion take place at the same time
- dental implant - insufficient bone (both vertically and laterally)
- application of Bio-Oss - filling the bone defect with Bio-Oss to form new bone
- use of Bio-Gide - in order to protect the forming bone, the wound is covered with Bio-Gide membrane
- Two-stage- insertion of the implant only takes place after completion of the bone reconstruction after approx. 6 months
- use of Bio-Oss - filling a bone defect with Bio-oss material to create new bone (e.g. Sinus Lift)
- use of Bio-Gide - in order to protect the forming bone, the wound is covered with Bio-Gide membrane
- dental implant - is inserted after the completion of the bone reconstruction, i.e. after approx. 5-6 months
Ref. 2 - Ridge Splitting
When the surgical field is exposed during the procedure, it may be found that according to clinical examination and model analysis, the top of the alveolar process is wide enough for the procedure, but a concavity is visible on the vestibular side. Alveolar undercutting occurs in approximately 6% of cases, and an overly narrow alveolar process statistically in 35% would disqualify the patient for the procedure.
The decision to expand the procedure has to be made many times by the doctor during the operation itself. It is only clinically during the procedure that the need for alveolar reconstruction or expansion in a specific area can be seen. Routine radiological analysis may sometimes not give a complete picture of the clinical situation, e.g. it does not fully determine the quality of the bone.
In cases of atrophy of the alveolar process only in the anteroposterior dimension, i.e. when it is high enough but very thin and narrow, a technique called Ridge Splitting is applied.
Using piezosurgery, the bone is dissected along the top of the appendix, to a depth of approximately 1.5-2 cm, and then the dissected bone lamellae are dissected with hand tools. Implants are inserted into the space between the dissected appendicular lamellae to maintain the achieved bone width. The remaining free spaces between the dissected appendicular plates are filled with Bio-Oss biomaterial. The entire treatment area is finally covered with a resorbable Bio-Gide membrane and sutured. The pressure of the split bone plates on the implant has a positive effect on its stabilisation and contributes to better contact between bone and implant surface.
With the use of biomaterials, it is possible to reconstruct bone, while the use of suitable barrier membranes (membranes) not only results in better wound healing, but also produces the maximum amount of hard tissue in the desired direction and height.
Ref. 3 - Sinus lift
Difficult conditions for the insertion of implants are most often found in the posterior alveolar regions of the jaws : as a result of pneumatisation of the sinuses (with age) and when teeth are missing, the alveolar process atrophies.
One of the methods that allows us to use implants in this particular area is to lift the sinus floor and insert autogenous bone or biomaterials into the space created between the bottom of the maxillary sinus.The maxillary sinus cavity and the elevated mucous membrane lining the maxillary sinus cavity.
The high success rate of this type of procedure and the possibility of a single-stage implant insertion have led to the rapid adoption of the sinus lift procedure in implant treatment planning.
The healing of implants, inserted with a sinus floor lift, usually proceeds without complications, although the time is significantly prolonged.
The elevation of the maxillary sinus floor opens up new possibilities for implant treatment, as it allows implants to be inserted in difficult anatomical conditions, especially in lateral sections within the jaw.
1. LATERAL APPROACH METHOD
With the lateral approach method, we can lift the sinus 5.0-8.0 mm more than with the closed method, which is why they are performed most often.
- First, a window of access to the sinus floor is created and then the sinus membrane is gently undermined.
- The area prepared in this way is filled with biomaterial and covered with a special barrier membrane and mucous membrane, before being carefully closed again.
- The healing time is approximately six months.
- In exceptional cases where the existing bone thickness provides primary implant stabilisation, it is possible to insert implants at the same time, but this does not shorten the healing period.
2. CLOSED METHOD
With the closed method, it is possible to lift the maxillary sinus floor by a maximum of 3.0-3.5 mm, but practically always the procedure is accompanied by the simultaneous insertion of an implant. The procedure carries a greater risk of perforation of the mucosa of the maxillary sinus floor, which is related to the fact that it is performed without full visual control. This risk can be minimised by using a thorough radiological diagnosis before the procedure.
In both methods, as usual, the experience of the surgeon is paramount.
And in particular, the correct assessment of the bone resistance felt during the procedure, related to the change in bone density in the area of the lamina propria. The management of sinus membrane rupture is still the subject of much controversy. There are even opinions that minor perforations of the mucosa do not disqualify this type of procedure and that the insertion of an implant is acceptable after such a complication. However, continuous radiological follow-up is necessary.
Ref. 4 - Autogenous bone grafts
The use of autogenous bone, i.e. the patient's own bone, is becoming increasingly popular in regenerative procedures. However, the application of autogenous bone is limited by its availability and the stress for the patient associated with the subsequent procedure.
Bone is taken under local anaesthesia.
The extracted fragment is then fixed with special screws at the chosen site where there is insufficient own bone material. After a period of usually six months, we have full-fledged augmented tissue ready to receive the implant.
Ref. 5 - Piezosurgery
NEW PRECISELY SAFE SURGICAL TECHNIQUES stosated at UNIDENT UNION® in cases of implant treatment.
It is a modern bone surgery technique for use in periodontics and implantology.
It surpasses traditional surgical techniques because it allows for MIKROMETRIC cutting, characterised by exceptional precision and safety. It strongly reduces tissue destruction, especially of soft tissues. Selective cutting is possible, associated with the use of ultrasound at different frequencies - one that allows the cutting of mineralised hard tissue without destroying other delicate anatomical structures. The treatment area is almost completely free of blood
Due to its high level of accuracy and the possibility of saving tissue (selective cutting), piezosurgery is the method of choice when preparing the implant bed.
