In today’s world, there are more treatment options than ever when it comes to replacing missing teeth – and perhaps, just as many questions for every one of those options. Nevertheless, perhaps the best option for most patients – dental implants, and the bone grafts that go with them – seems to be shrouded in the most mystery.
Thankfully, knowledge is power – that’s why we sat down with Dental Depot’s Dr. Chandler Kuhlman, to answer all of your questions about dental implants and bone grafting.
A bone graft is like spackling a hole. The spackle is made from bone particles that go into the hole where the tooth used to be, and is covered that by a sterile bandage called a membrane. Then, the body dissolves the bone partials and integrates it into the person’s own bone.
It’s a space-maintainer. It’s a scaffold. The body wants to heal a wound by collapsing it in, so by spackling that hole it fills that space. When we look at things like nerves and sinuses, we don’t want to lose any height on the bone, which could ultimately prevent the patient from getting an implant. So if we spackle that hole and keep the walls where they are, we’ve got a better shot at putting a successful implant in.
The bone will heal, but it will heal in its own way – meaning that the walls that used to house that tooth could collapse in and cause you to lose height of bone and you may also lose width of bone. The more bone that you lose, the less likely you are to be a good candidate for an implant.
It’s very difficult to rebuild height in the bone, so we try to maintain it while we have it with the bone grafts. I’ll talk to patients and tell them, “Okay, your options are to do nothing, get a bridge, get an implant,” and they may say they can’t afford an implant right now.
But that’s the magic word – right now – so I ask them, “If money is no option, would you choose an implant?” And they’ll say yes, they want to replace that tooth but they can’t do it now, so I tell them it’ll benefit them to do the bone graft now, so we can try and maintain the bone until your insurance rolls over or whatever the case may be, so that down the line you can get that implant.
If a patient goes ahead with a bone graft and then waits five years, there’s still a chance that the bone may dissolve – but if a patient is maxed out on their insurance for the year and it’s only July, then yes, you can wait until next January when your insurance starts over.
The bone graft has to heal for a minimum of four months to be strong enough to support a dental implant.
Ideally, the extraction happens and we do the bone graft and membrane in the same appointment. Then, the patient needs to heal for four months. Next, we place the implant – which is just the titanium screw – and that needs to heal for a minimum of four months. Then, we uncover the implant and let it heal for about a month. While that’s healing, our lab spends about a month perfecting the crown. Now, if it’s a front tooth there could be multiple visits for fittings to get the tooth color matched and blended in perfectly.
Yes. We can create a temporary in the form of a thin, clear mouth guard with a fake teeth in it or a single fake tooth on a retainer. If the missing tooth is located in the back of the mouth, it may not be necessary to create that temporary, as it won’t be seen when the patient smiles.
The temporary allows patients to go to work, go to school, go to church and not have that gap in their smile. They would need to remove it before eating anything, as it is only for cosmetic purposes and won’t support chewing or biting.
No. A lot of people have this misconception that you need one implant per tooth, but we can actually put an entire jaw’s worth of teeth on four implants. But people will come in and say, “I know an implant is $3,000 a piece and I’m missing four teeth, so I’m looking at $12,000.” I’ll say, “No, you’re not. You’re looking at two implants and a bridge and you’re probably only looking at $5,000 to $6,000.” We try to keep our care as affordable and accessible as possible, so that people can get the care they need without breaking the bank.
There are people who come in and think that implants are $10,000 to $12,000 apiece. So we say to them, “Okay, we’re going to take this tooth out. What do you want to do?” And they’ll say they couldn’t ever afford an implant, so I’ll show them the treatment plan so they see how we’ll work it out. They’ll ask, “Well, about how much is it?” and I’ll say it’s about $3500 and with the special for $2499, they’ll realize that they can actually afford it. The pricing is the big thing. But it’s really neat how we can place four implants and replace an entire jaw’s worth of teeth.
Including an extraction, the bone graft and membrane procedure may take up to 45 minutes, depending on how cantankerous the tooth is. To place the implant with our guided surgery, that appointment shouldn’t take more than an hour.
The patient can be wide awake and get the shots of Novocain to numb the area. They’ll feel me pushing for a little bit, and then if we’re placing the implant they’ll feel a little vibration, like we’re doing a filling, and that’s it.
At the other end of the spectrum, we have a nurse anesthetist who can give the patient an IV and they’ll go completely to sleep. It’s not general anesthesia where they put the tube in your throat, there’s just enough medicine to help them fall completely asleep.
In between, they can do a little bit of nitrous oxide – laughing gas. Or if the patient wants to be more asleep, we can give them a pill and that’ll help them feel closer to taking a nap.
Patients will ask about awake, asleep or somewhere in between and most people choose that somewhere in between with the pill. Most people do really, really well with that. They’re far enough sedated that they can still respond if I need them to open wider or move a little bit, but they’ll come back a week later to take out stitches and say, “Man I don’t know what you gave me but it’s good stuff.”
Most patients choose to do the pill. It’s the easiest on the pocketbook and it’s the easiest in terms of scheduling.
For both the pill and the IV, the patient has to have a driver who remains onsite in our reception area. We encourage the driver to bring a snack or a tablet, bring whatever they need to remain comfortable – but they must remain in the lobby so that nothing happens to them. We don’t want them to pull out of the parking lot to run errands and get hit by a car because then we have a sedated patient with an injured driver.
From a bone graft and membrane, your gums might feel sore, as if you bit wrong on a chip and it made your gums hurt.
With an implant, there’s no pain from the implant, but the gums can be a little sore – similar to that same bit-wrong-into-a-chip feeling, but it’s much easier on the patient than pulling a tooth.
Extremely. The potential risks are rejection of the graft – which is highly unlikely; or infection, which again, is highly unlikely. We give seven days’ worth of antibiotics to try and combat that. Lastly, the body could dissolve the bone graft faster than it can turn it into bone, in which case there may need to be a second graft that is necessary.
While there are no eating restrictions after a bone graft, try to eat on the opposite side of the grafting place for about 3 to 4 weeks. But hot or cold, soft or hard – anything is on the menu. The less their tongue plays with the graft the better chance they have of healing. The less the patient doesn’t put their finger in their mouth or put a tooth pick in there, the better.
Cadavers. It can also come from cows – bovine. It can also be what’s known as “chemical bone.” However, the best is cadaver bone. It can also come from the patient, but that’s a procedure that an oral surgeon would have to do.
Once in a blue moon somebody will say they don’t want to have the bone graft done with cadaver bone. Once you explain that the body dissolves that donor bone and turns it into the patient’s own bone, most people are comfortable with it.
Typically it takes about a half a CC, so very, very little.
A bone graft can get infected – the mouth is the dirtiest place in the human body and even with our best efforts, infection can set in.
The body could dissolve the bone graft faster than it can heal it, so not quite a failure but it may require us to re-graft it so you have enough.
The body may also flat out reject the bone graft and refuse to dissolve it, in which case we may have to go in and clean it out and at that point we don’t put anything back in so the body can heal the hole how it would normally. Then we may have to try a different grafting technique if there’s insufficient bone to put an implant into.
The membrane – which is that sterile bandage – holds the bone particles in the jaw. If the patient manipulates the area and makes the membrane raise up, then yes, the particles can come out.