Bone atrophy after loss of teeth is a physiological process. During the first 6 weeks after tooth extraction fades to 60% of bone tissue. Later the loss is slightly slower but still in progress. The less time after tooth loss is, the bigger chance of proper bone structure for dental implantation. Recently more and more implant surgeries have been performed on patients with large bone atrophy. These kinds of surgeries were not possible few years ago. Dental implants were placed in the mandibular bones only in places where the amount and tissue density was sufficient. It limited the use of dental implants. Because of quickly bone atrophy development, only about 30% of patients have good bone conditions and the implant will not find any problems. The rest of patients requires one of bone restoration technology to be used. They are as follows:
- GBR guided bone regeneration
- sinus lift
- ridge splitting
- bone condensation with piezosurgery
GBR guided bone regeneration
It is the placement of a natural patient’s bone (taken from the other place) in the place of bone tissue deficiency Instead of the natural bone, artificial bone can be inserted after covering with special barrier membrane. It prevents against soft tissue ingrowth on the regenerated area. After a few months of regeneration and remodelling processes activity, the material is rebuilt into bone tissue of standard value in which a doctor can insert implants. Natural or artificial bone works as a matrix (or staging) for bone regeneration and the patient’s bone rebuilding process. The application of autogenous bone (own patient’s bone) is, however, limited by its availability. Is the “golden standard” in the implantology. If we do not have sufficient bone amount or we do not want to perform additional surgery, we use biomaterials or synthetic bone substitutes which have natural, mineral bone structure similar to human’s tissue. The use of biomaterials connected with a membrane delivers the complete regeneration of damaged bone around the dental implant or helps in widening the lost bone in required direction. In the future it will be very often not distinguished from a natural one on an X-ray photo.
Sinus is a pneumatic cavity which is a part of paranasal sinus and it is connected to the nasal ducts. Physiological sinus is situated over the teeth tips from 4 to 7. The sinus inside is covered with a thin mucosa known as Schneider’s membrane. When we speak about teeth loss in the posterior part of the maxilla, unstimulated bone is resorpted and it is followed by lack of bones quantity and quality. The solution is the sinus lift surgery which is based on missed bone rebuilding through making the sinus shallower. The first sinus lift surgery was performed by dr H. Tatum Jr in 1975 with the lateral access technology with patient’s bone complement. The surgery itself is based on sinus opening through the lateral wall in maxilla, mucosa separation, its lift and artificial bone placement. The greatest advantage of this method is the possibility of sinus lift on the wide range. If the amount of natural patient’s bone is sufficient for good dental implant stabilization, also implants can be fixed during the surgery. However, if the proper dental implant anchorage is not possible, their placement should be postpone for about 6 months.
This technology is used if the bone is too thin for dental implants placement both in the maxilla and the mandible as well. It is based on section along the ridge of cortical plate, dividing it in two parts and placing dental implants between them. In the created surface the idiopathic process takes place and after about 4-6 months the division area is not visible on the X-ray photo.