In years past, surgical tooth extractions were performed without also performing a bone graft to preserve the shape and size of the jaw bone tissue, which can shrink when not stimulated by a tooth’s natural root. Unfortunately, when a jaw bone shrinks, a dental implant can’t be immediately placed until the jaw bone tissue is surgically rebuilt.
Today, everything’s changed. It’s now possible to perform tooth removal surgery while simultaneously protecting the jaw bone tissue from shrinking, as well as regenerating jaw bone tissue loss from previous tooth extractions through a procedure known as bone regeneration.
The process of simultaneously removing a tooth and performing a bone grafting surgery is called socket preservation. This procedure prevents jaw bone resorption from ever taking place. First, the extraction of the tooth must be performed in a conservative manner, so as to promote fast healing. To ensure this, periodontist Dr. Kissel typically uses microsurgery techniques when extracting the affected tooth.
Next, the empty tooth socket is grafted with a mixture of bone graft materials; then the surgical site is covered with a collagen barrier. This barrier contains the graft, as well as separates it from the adjacent gum tissue. Finally, the nearby gum tissue is very carefully advanced, thus reducing the risk of exposing the gum graft to the rest of the mouth.
All in all, socket preservation usually takes between 1.5 to 2 hours to complete. Because Dr. Kissel uses microsurgery techniques on his bone regeneration patients, they usually report little to no discomfort or swelling. Most of Dr. Kissel’s patients report that the most inconvenient side effects from the surgery are not being able to chew on the surgical site for about 2-3 weeks after the procedure and needing to waiting about 4 months after this pre-surgery for dental implants to be placed.
Patients who have previously had tooth extractions, and as a result lost jaw bone tissue, will require a vastly different process for bone regeneration. For example, pretend that a wood floor (the bone) underneath the carpet (the gum tissue) has a large hole. As a result, the carpet is displaced into the wood floor. The furniture in the room (which represents pressure from forces such as the mouth’s cheeks, lips and the process of eating) are also present over the hole in the wood floor and placing pressure on that spot.
In this example, the only way to restore the hole is to place rigid struts in the floor to bridge the gap present in the floor. A material that wasn’t rigid wouldn’t be able to withstand the pressure from the carpet and the furniture. As a result, the floor would collapse. This illustration is often the same for those who have jaw bone recession and have dental implants placed without bone regeneration.
You see, lost jaw bone tissue is the same as the hole in the wood floor. To rebuild the bone, certain materials are needed to maintain the desired shape of the bone underneath the jaw bone tissue. A bone graft is the solution. Rigid, non-resorbable materials are needed in order to prevent compression. This means that after the jaw bone tissue rebuilding process is successful, an additional surgery will be required to remove the non-resorbable materials from the surgical site.
Most periodontists aren’t comfortable using the rigid, non-resorbable materials that Dr. Kissel uses because it does require that additional surgery to extract the materials once the jaw bone tissue has regenerated. Many also aren’t properly skilled and trained to perform this procedure. But Dr. Kissel, who is skilled at regenerating jaw bone tissue with rigid materials, can perform this two-step surgery to give you the best chance at long-term results.
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