Today, more than ever, advances in medicine and dentistry have led to new and expanded areas of treatment. Two such areas, bone grafting and guided bone regeneration (GBR) in the jaw bones and around teeth, have recently experienced tremendous growth. Procedures to repair and grow new bones, unheard of just a few years ago, are now part of routine periodontal surgical care. This section of our web site will help you better understand what bone grafting and GBR are, what options are available to you, and what benefits you may gain from these procedures.



What are bone grafting and GBR?

Bone grafting is a surgical procedure that replaces missing bone with a material called a bone graft. In addition, the graft also helps your body regrow lost bone. This new bone growth strengthens the grafted area by forming a bridge between your existing bone and the graft. Over time the newly formed bone will replace much of the grafted material. GBR is a procedure in which a membrane is placed over the bone graft site. This membrane futher encourages new bone to grow and also prevents the growth of scar tissue into the grafted site.



Why are bone grafts and GBR needed?

Bone grafts and GBR are needed when a part of your body is missing bone. This missing portion of bone is frequently called a "bony defect". Examples of jaw bone defects are: defects surrounding roots of teeth (periodontal defects); defects which occur following tooth extraction; generalized decrease in quantity of jaw bone from trauma or long-term tooth loss; defects surrouding dental implants; defects resulting from a cyst or tumour.



What are some jaw bone defects requiring grafting and GBR?


Periodontal defects


Defects following tooth extraction


Defects following cyst or tumor removal


Defects around dental implants


Insufficient amount of jaw bone to support dentures or bridges



How are bone grafting and GBR procedures performed?

The following is one example of these procedures following tooth extraction.



1. The tooth is removed and the remaining tooth socket is thoroughly cleaned of all inflamed and infected tissue.


2. An appropriate bone grafting material  is carefully placed into the extraction socket.


3. GBR membrane is often placed over the grafted material.



4. Sutures placed into the gum tissue allow proper healing of the surrounding soft tissues.



Are bone grafting and GBR painful procedures?

These procedures are usually done in our office under local anaesthesia or local anaesthesia with oral or intravenous sedation. The procedures themselves are without pain. Post-operatively there will be some swelling and some mild to moderate discomfort, especially from other procedures performed such as tooth extraction, cyst removal, etc. I will prescribe an oral analgesic to help relieve your discomfort. If a more invasive second procedure is required to obtain bone from your jaw such as where the wisdom teeth were or the chin area then your post-operative course may be more involved but still manageable.


What special care is required after my grafting procedure?

Generally, the same prudent care required after any periodontal surgical procedure will be sufficient following jaw bone grafting and BGR. The area must be kept clean, often with the help of a prescribed mouth rinse. An antibiotic, if prescribed, must be taken as directed. Antibiotics, however, are not always required. Undue pressure over the grafted site must be avoided until new bone is well on its way to being formed. This means that previous dental prostheses, such as a removable full or partial denture, must be altered following the grafting procedure and may not be reintroduced until the initial healing is completed (usually about two weeks). Finally, brush and floss your teeth and gums as you normally do. However, avoid the gum tissues surrounding the bone graft until they are well healed (usually about six weeks).



How successful are bone grafting and GBR?

Recent advances in technology have dramatically increased the success rate of these procedures, leading to bone formation and resolution of the defect. However, depending upon the reason needed for these procedures, success rates will vary. Also, different graft and GBR materials seem to affect the amount of new bone formed. And finally, your own overall health will also help determine the degree to which new bone will form within the grafted site.



Are there different types of bone grafts and GBR membranes?

Yes. Some grafts are taken from different parts of the patients own body (ie. from the hip bone or chin). Other grafts come from the deceased human organ donors, from synthetic materials, and from highly purified animal bone material. Likewise, there are different types of GBR membranes. Some are made from synthetic polymers and must be removed during a second surgery several weeks or months later. Others are made from natural materials and are gradually resorbed (melt away) by the body.