In recent decades, great progress has been made in all areas of dentistry, particularly in prosthodontics. Today, alongside fillings or crowns, it is quite natural for someone to have missing teeth replaced with implants.

A highly advantageous alternative, as implants are not only extremely durable but also address both aesthetic and functional problems. However, few realise that there are conditions for the successful application of this technology.

One such factor is the presence of sufficient bone stock, which is a common problem. If there is insufficient bone stock, bone augmentation must be performed, after which the implant can be placed. However, the patient must expect a longer process, as bone formation must first be ensured, and only then, after providing adequate support, can the tooth implant be carried out.

Csontritkulás, más néven csontvesztés, akkor alakul ki, amikor a szervezet több csontot veszít, mint amennyit termel. Ez a csontsűrűség csökkenéséhez vezet, így a csontok gyengébbé és törékenyebbé válnak.

Before we go into more detail about methods of promoting bone formation, it is worth briefly considering what causes bone loss.

DentistryFrom this perspective, the loss of bone tissue is most often caused by the removal of a tooth for some reason. Due to the missing tooth, the gum remains empty, meaning there is no need for the bone to be maintained in the same quantity and quality as with an existing tooth.

This is because the gum surface in question is not subjected to stress during chewing, causing the underlying bone to weaken and resorb.

It is important to note that certain illnesses can also negatively affect bone density deficiencies. Periodontal disease, for example, is particularly common, as are genetic factors such as having a jawbone that is too thin and narrow.

It's interesting that after the implant has been placed, there's no longer any need to fear the development of bone loss – or its potential recurrence – because the jawbone regains its function, takes on a role in chewing again, meaning it receives the load it needs to maintain its condition.

Why and when is it necessary to promote bone formation during implant placement?

Maintaining healthy gums and teeth is important in itself for the quality of chewing and to keep your jawbone strong. However, it is also essential when implants are needed, as the bone structure provides the proper support for the procedure.

If this bone stock is damaged for some reason, or its quantity and quality are insufficient, then the first step in implant placement is always bone grafting.

In most cases, this is sufficient in itself, but one must always account for other changes as well. Such as periodontal disease, where the tooth bone begins to decay in a crater-like manner. This needs to be alleviated with a separate procedure around the tooth, which we call regenerative flap surgery.

Although the very names of these two procedures often cause alarm in patients, with modern local anaesthesia, they can be carried out with minimal discomfort.

Csontpótlási eljárás

A bone replacement Dentists use various methods in relation to this.
When and which one is needed is primarily determined by where it is needed:

• on the lower or upper jaw;
• and the anterior and posterior half of the jawbone.

If a bone defect develops in the posterior part of the upper jaw, the procedure is generally carried out using a so-called bone window created in the cheekbone. Following the elevation of the sinus floor, the special bone graft material or the patient's own bone is placed here.

However, if bone grafting is performed on the anterior part of the upper jaw or on the complete lower jaw, then two other technologies can be applied. One is when the surface is strengthened using so-called bone augmentation.

This can be performed as part of a plastic surgery procedure using a bone block, bone graft, or a bone substitute mixture. The other method is a little more complex. In this case, the jawbone is simply fractured and then widened. The latter is rarely performed in modern dentistry.

Bone grafting can be done with what materials?

When it comes to bone grafting, it's worth familiarising yourself with the materials used in the procedure, as well as the techniques employed.

It is important to know that dentists make decisions in this matter on a case-by-case basis, adapting to the specific situation. This can be determined by the planned location of the implant, the extent of bone loss, and even the patient's anatomical characteristics.

A wide variety of materials can be used for bone grafting. In addition to synthetic bone graft materials, for example, the graft may sometimes be sourced from sterilised animal or human bone tissue, but in certain cases, using the patient's own bone is preferred.

This is particularly common in significant bone defects, where one's own bone graft is always the most favourable and safest alternative. In most cases, the bone is harvested from the bones around the mouth. Very good results can also be achieved by using a combination of bone substitute and one's own bone.

Finally, but by no means least, we must also address extreme bone loss. In such cases, it is not uncommon to need to harvest bone from outside the mouth, for example, from the hip, and transplant it into the oral cavity to achieve the desired overall effect.

How can we promote bone formation?

As has already become clear from the above, maintaining proper bone structure is also very important from a dental perspective. Although one characteristic of human bone is its ability to rebuild itself, its pace is very slow, and it even decreases further with age.

A bigger problem is that as soon as the jawbone loses its function – for example, due to an extracted or lost tooth from an accident – it immediately begins to deteriorate, making implant placement impossible in the long term.

If we want to avoid this, or if our bones are weaker, then it is important that we do something about it. What?

A calcium-rich diet, for example, is very beneficial for both teeth and bones, so let's ensure that we provide this mineral to our body, whether through diet or by taking supplements.

In addition, attention must also be paid to vitamin intake. Vitamins C, D, and K are particularly important for bones and teeth. The former plays a role in the production of bone-forming cells, and while vitamin D is essential for calcium incorporation, vitamin K plays a significant role in bone metabolism.

The process of bone grafting

Disclosure and diagnosis

If a patient decides they need an implant, the first step is always exploration and diagnosis. A dental 3D CT scan can be taken during the first consultation, which is sufficient for the dentist to get a complete picture of the condition of the jawbone.

Based on the images obtained, the treating physician can precisely plan the implant placement and the entire bone grafting process. This will naturally also require a physical examination, which is usually painless and is always followed by thorough planning.

With this background, a written treatment plan can be prepared, from which the patient can also learn what methods, techniques and materials the treating physician will use for the bone augmentation, and based on this knowledge, a final price quote can be given.

Preparation of the oral cavity

Once the problematic jawbone has been exposed and a reconstruction plan is in place, the next step is to prepare the oral cavity for the procedure. Dental hygiene treatments, such as tartar removal or the repair of decayed teeth and fillings, are often necessary at this stage.

This is all essential to make the oral cavity as clean and germ-free as possible, which is vital before bone grafting.

Bone graft procedure

Bone grafting is actually a minor surgical procedure that is performed under local anaesthesia, so the patient normally feels hardly any pain. Regardless of the technology used, after the anaesthetic has been administered, the oral surgeon first opens up the section of gum to be treated.

Through this „window,” the bone graft material – which can be synthetic, or even the patient's own bone or bone granules – is placed in the correct position, and then, if necessary, the doctor performing the procedure covers the treated area with a membrane and finally sutures it for prompt healing.

The recovery phase

Bone grafting is not a major surgery, however, it is located very close to sensitive areas, thus requiring immense attention from the patient in multiple respects. This is especially true considering that the healing process is measured not in days or weeks, but rather in months.

Generally speaking, a bone graft requires 4-6 months for complete healing. This interval tends to be on the longer side, and demands a great deal of attention and self-discipline from the patient.

This is because the treated area must not be subjected to any load whatsoever until the healing period is over. For this reason, the implantation can only be performed if the specialist, during the follow-up examination, believes that a sufficiently strong structure has formed through bone regeneration initiated after the procedure for the implant to be placed.

If you require bone augmentation or a dental implant placement, Book an appointment for a consultation now and get to know your unique opportunities.