In severe gingival recession, periodontitis and periodontal abscess, there is loosening of teeth due to loss of the supporting bone. This requires dental bone grafting in order to restore the normal level of the bone and to reduce the mobility of the teeth. There are two options for finding a bone transplant as with mucosal grafting.
The first option is the use of own bone, which can be taken from different parts of the body (skull bones, pelvic bones, the lower jaw), but due to the need for a second operation, the discomfort of the patient and other factors, this method is hardly applicable.
The second option is to use a bone void filler in the form particles of various size (bone granules/pellets) or blocks of bone.
Bone void fillers in the form of granules or pellets may be either allograft (bone from a digested donor) or synthetic (hydroxyapatite). They are used for filling small bone defects. The choice of a specific size and type of the granules of the substitute bone is made by the dentist, based on individual characteristics of the patient. In large bone loss, it is recommended to use bone void filler in the form of ready-made blocks. This is necessary due to the fact that the bone blocks are more stable during the healing process and more resistant to physiological resorption (the organism degrades excess bone during healing).
Another great advantage of bone blocks is that they can be modeled exactly to the shape of the bone defect and fully restore the original appearance and size of the alveolar bone. A disadvantage of this type of bone void filler is the high cost of the bone block.
Dental bone grafting is also a microsurgical periodontal procedure. An anesthesia is given in advance and the whole operation is painless. It flows through four stages.
The first stage is the opening of the mucosal flap (the gums are separated from the bone) and the site, where the bone is missing, is located. This place is carefully cleaned and shaped in an appropriate form – open curettage. After the bone defect has been prepared, the necessary amount of bone void filler is placed during the second stage.
The third stage is putting the regenerative membrane. It is a synthetic Teflon or natural resorbable dried pericardial membrane. It is very important, because it guides bone regeneration (read more about GBR). As it is known, the mucous membrane (gum) heals in about 7 to 10 days, and the bone requires from 3 to 6 months for complete recovery. The membrane is placed and sutured between the gum and bone, and protects the bone graft until it turns to healthy bone. In the fourth stage the gum is sutured so that it covers the whole bone graft. If there is not sufficient gum tissue, mucosal grafting can be carried out in order to achieve full coverage of the bone graft.