Special Report By Dr. Vadivel
BONE GRAFTING:WHO NEEDS IT AND HOW IT WORKS
“For a complete Dental wimp like me, Dr. Vadivel and his staff did everything they could possibly do to make my double wisdom tooth extraction as drama-free, and non-scary as possible!” – Elijah B.
If you are someone that has lost a tooth or several teeth either recently or in the distant past, this Special Report is for you. It could help you fix your teeth, regain your sense of self-confidence, and help you create a plan of action to get your appearance back.
Before I explain how, you should first know who I am.
I’m Dr. Kumar Vadivel, a highly regarded and well-known dentist in your area. I’m not just an ordinary dentist. I’m not someone who just got out of dental school and hasn’t been practicing very long. No, that’s not me. I’ve been practicing for 24 years, and loving every minute of it!
I’m also not like a lot of dentists that chose the profession for money and prestige. I’m in the business to create fabulous smiles and long-lasting teeth that are still sound when people are in the grave. In fact, I can’t imagine why a dentist wouldn’t make anything else his or her goal!
I’m one of a selected number of dentists that consciously made the decision to go the distance for my patients. That means getting further education in specialty areas – such as bone grafting, implants and cosmetic dentistry.
There’s so much to this subject of bone grafting – and with all my training – and thousands of patient visits over the years, I am able to help patients that I never could before as a beginning dentist.
What is Bone Grafting?
You may have been told you need bone grafting or think it’s something that could help you from your research online.
Bone grafting is a modern dental procedure that is routine, predictable and painless. It’s used for many different types of patients. For example, those that have periodontal disease and lost bone tissue in their jaws will benefit. It’s for those who have lost a tooth and those who have lost bone tissue near the area where a tooth has degenerated.
Bone grafting is also for those who have experienced trauma that has hurt their jawbone, those who have a cyst, and those that have had tooth loss for a long time and thought they would never be able to chew again because dentures won’t fit.
Do any of these situations fit for you?
Why Does Someone Need Bone Grafting?
To understand why someone needs bone grafting, let’s start out with looking at two pictures of jawbones.
Photo source: http://www.cmsllc.com/procedures/bone-grafting-dental-implants/
In Figure 1, this is a normal lower jawbone. The holes in the jawbone are the sockets for teeth. Notice that there’s more than an inch of jawbone underneath the teeth sockets if you imagine the jawbone in its real dimensions.
In Figure 2, that same jawbone has withered away. If you can imagine there’s a face attached to this jaw, then the person’s lower face would drop and you wouldn’t see the natural jawline – because the bone has been resorbed. The face behind this jaw is one that looks like the lips have “fallen in”, that is, fallen inside the large hole of the jawbone. The person looks old.
The same thing happens if only one tooth is lost, although the loss of bone in the jaw is generally localized – only found in the area where the tooth was lost.
The big questions to ask about what’s going on here are the following:
1. Where did the bone go?
2. What made the bone go away?
3. Doesn’t the body make new bone all the time? Why isn’t the body making new bone in the jaw in
4. Can the bone in the jaw ever come back?
Let’s answer them now so you will understand what’s happening and how it relates to bone grafting.
Where Did The Bone Go?
The jawbone is made of bone and connective tissue. The connective tissue is made of primarily collagen protein Inside the connective tissue are tooth roots. Teeth are attached to the jawbone via the tooth roots. Every time you chew hard foods, the teeth are stimulating the bone of the jaw. It’s a good thing to chew. So imagine the benefits that the jaw is receiving from 20 minutes of eating hard chewable foods three times a day.
The stimulation on the jawbone is similar to what happens in the gym when you lift weights. As long as you keep going back to the gym, your biceps and abs and quads look excellent. But stop working out and it won’t be long – maybe a few months – before those muscles end up looking as if you don’t work out at all.
The old adage, use it or lose it holds true for both your body muscles and your jawbone.
And if you don’t use your jawbone enough, there’s no reason for it to stay “beefed up”. It begins to wither away, or technically, this is called bone resorption. Bone resorption means the body uses the bone for other purposes – such as feeding an ailing bone elsewhere in the body or improving your bone density in your spine.
There are four primary reasons why the bone goes away:
1. The bone cells are not in the proper combination to foster strong bone growth.
2. The hormones aren’t adequate to keep the bones strong.
3. The nutrients are deficient and the bone won’t build up.
4. There aren’t sufficient mechanical forces on the bone to make it grow and keep it strong.
Certain types of cells, vitamins and minerals, and certain types of hormones control the process of bone resorption. There are two main types of bone cells – osteoblasts and osteoclasts. Both of them live in your bone at all times. The osteoblasts create new bone while the osteoclasts break down old bone or bone that doesn’t need to be around anymore – such as in the jawbone where teeth have been pulled. There’s no more need for the body to keep the bone there so the osteoclasts get really busy and take it down.
You could think of it as similar to what happens when a concert is coming to an outdoor event. The hired stagehands come in to set up the framework of the stage for the band to perform on. The stagehands are the osteoblasts. After the concert, there’s no more need for the stage so the new crew comes in to break it down. These are equivalent to the osteoclasts.
Hormones Control The Bone, Too
Meanwhile, there are hormones that are controlling those osteoblasts and osteoclasts.
Vitamin D helps the osteoblasts collect calcium for the process of making new bone. Without vitamin D, new bone won’t be made properly and it will be weak – if it’s made at all. Vitamin D forms a hormone called calcitriol and – and yet so many people are deficient in this important vitamin. Your teeth won’t ever be at their best if you have a low level of vitamin D. So do make sure to get your vitamin D level checked at least once a year.
Parathyroid hormone is another hormone that is important for bone balance in the body. It’s a potent stimulator of the osteoclasts and inhibits the osteoblasts to make new bone.
Glucocorticoids are potent inhibitors of bone formation. Steroids interfere with the process of bone formation, and when they are injected into a joint, cause the bone to dwindle in volume.
Growth hormone helps your body create new bones. Testosterone and estrogen also build up bone in the body, which explains why women and men are more prone to develop brittle bones after menopause and andropause. When you’re older, it takes longer to build up the bone mass anywhere in the body.
Calcium and phosphorus are important for bone to build itself up. If either of these two is in low amounts, the hormones will remove the nutrients from the bone to fulfill other functions in the body. Nutritional deficiencies can result in the formation of weak, poorly mineralized bone.
Doesn’t the Body Make New Bone All the Time?
Your body is constantly engaged in a process of making new bone and disassembling old bone. Lack of exercise, staying in bed for long periods of time due to illness and smoking all have negative effects on bone mass and strength.
Exercise provides the mechanical forces needed to keep the bones strong. Chewing is the exercise that the jawbone needs to keep up its bone density.
Sometimes certain medications will also cause the bone to die in the jawbone. Osteoporosis medication is notorious for causing this problem.In fact, this topic is SO important when it comes to the need for bone grafting that I have a small section on it right here. If it doesn’t pertain to your situation, skip down to the next section, okay?
History of Bone Grafting
The bisphosphonate medications (used now for osteoporosis) were first created in the late 1800s but not used until 1968. The FDA approved them in 1995. Back in the 1970s and 1980s, dentists had to build a stable base for dentures to adhere to. Generally speaking, the patients that needed this done were ones that had suffered from bone resorption in their jaws that resulted from lack of stimulation to the jaws because of a missing tooth or teeth. The condition of the bone resorption was then named osteonecrosis (death of the bone) of the jaw.
By 2006, osteonecrosis of the jaw was generally described as an adverse drug reaction described as the progressive destruction and death of bone that affects the mandible (upper jaw) or maxilla (lower jaw) of patients exposed to the treatment with nitrogen-containing bisphosphonates, even if they did not have radiation treatment previously.
1. Bisphosphonates – these are antiresorptive
They are used in IV form to treat conditions of cancer, and high levels of calcium in the blood, problems with bone metastases, and multiple myeloma. In oral form, they are used to treat osteoporosis (brittle bones), osteopenia (low bone density), or other less common conditions such as Paget’s disease and osteogenesis imperfecta, a hereditary disorder that causes broken bones to occur.
2. Denosunab – This medication activates a receptor of nuclear factor kappa-B ligand (RANK-L) inhibitors. It is an anti-resorptive medication that inhibits the osteoclasts to work, decreases bone resorption, and increases bone density. It is used in treatment plans for osteoporosis or when cancers metastasize to the bones.
3. Anti-angiogenic therapies – Angiogenesis means the formation of new blood vessels. This is a natural process that occurs in the body on a daily basis, especially during growth spurts. In order for new bone to develop or be remodeled, there needs to be new blood vessels that feed the area.
Anti-angiogenic therapies are treatments that will stop the formation of new blood vessels throughout the body. They work by blocking the angiogenesis-signaling cascade.
The risk of osteonecrosis of the jaw in patients treated by oral-bisphosphonates after a tooth extraction is 0.5% while osteonecrosis of the jaw risk in patients with cancer treated with IV BPs ranges from 1.6% to 14.8%. The part of the jaw that is affected the most is the mandible (lower jaw), not the maxilla (upper jaw). Both jaws are affected in 4.5% of the cases.
The factors that make it more possible for the jaw bone to become resorbed occur include:
- treatment with the medication longer than 2 years
- type of treatment (IV rather than oral)
- other diseases in the patient at the same time, such as diabetes, rheumatoid arthritis, anemia, low levels of calcium in the blood, immunosuppression, softening of the bones, and dialysis)
- older age
- use of tobacco, steroids or alcohol
- genetic predisposition
- denture use
- older than age 65
- inflammatory diseases are present
- oral implants
- radiation therapy to the jaw
When the condition occurs and the patient needs to have an implant, the only thing recommended is a “drug holiday” before teeth extractions or the implant procedure. However, there’s no unanimous agreement on what to do amongst doctors. The drugs do damage by impairing the body’s ability to repair microfractures that occur daily in the jaw.
Can the Bone in the Jaw Ever Come Back?
The good news is that bone in the jaw will come back if modern dentistry methods are utilized. You are lucky to live in this generation.
Adding small bit of bone in the jaw where there is resorption can help build up bone and studies have shown that bone grafting works.
Bone grafting is a modern dental procedure that replaces missing bone with material from the patient’s own body, an artificial, synthetic or natural substitute. Bone grafting is possible because bone tissue has the ability to regenerate completely if provided the space into which it has to grow. As natural bone grows, it generally replaces the graft material completely, resulting in a fully integrated region of new bone.
There are three different results you can expect from bone grafting:
- The replacement of lost bone, degenerated bone or missing bone
- To fill in pockets of bone loss with a material to strengthen the bone
- To stimulate new bone and soft tissue growth
What Happens During the Procedure for Bone Grafting?
The procedure is pretty straightforward. Here are the steps:
- Numb the area.
- Separate the gums from the bone or tooth.
- If the tooth is still there, clean the bacteria and plaque off by root planning.
- Sculpt the bone to the desired shape.
- Add the bone graft material into the bony defect.
- May add a membrane on top of the graft site. Then reposition the gums and suture the area.
- The procedure for bone grafting takes from 3 to 9 months. New bone and tissue grows, strengthening the area.
What you’ve seen so far is that bone grafting really isn’t something to fear. It’s a procedure that makes a big difference in how you look, how your gums will heal, how you will feel.
Who Benefits from Bone Grafting?
- Those who have had periodontal disease and lost bone tissue
- Those who have lost a tooth and the bone near where the tooth was has degenerated.
- A cyst
- Long term tooth loss
Are There Any Risks in the Surgery?
All medical procedures come with common risks such as reactions to certain medicines, bleeding, and infection. In case of bone grafting, less than 1% infections have been reported. Patients who suffer from other illnesses are more likely to develop infections as opposed to healthy patients.
What are the Post-Surgery Precautions?
Here are some easy precautions to take after a bone grafting surgery to help you recover faster:
- Avoid rinsing your mouth vigorously or brushing your teeth for the first 24 hours, as you risk bleeding.
- Don’t use straws for the first 2 days.
- Avoid smoking for 2 days.
- Place ice on both sides of your mouth to reduce swelling.
- Start with a liquid diet, followed by soft food. Drink lots of water and avoid chewing around the site of surgery for a few days.
You’ve had a chance to discover the details about bone grafting. Now it’s time to learn a bit more about my practice and me and how I could potentially help you.
Why Choose Dr. V at Implants & Gumcare?
Our dental office at Implants & Gumcare is different from many other dental offices. First, we use the latest and most advanced dental equipment and procedures to serve you better. With all these new techniques, we can be sure we are offering the best dental care you will receive.
Secondly, we offer free initial tooth CAT scan and consultation exams.
Thirdly, we have two convenient locations and won’t make you wait days or weeks for dental emergencies.
Fourth, my experience and training in bone grafts as well as other services allows me to give professional services in this area that exceed the minimal criteria and service others may be offering.
You will find my staff quick to assist you in your needs, questions and concerns in a compassionate, caring manner.
And lastly, we will never give up on you! Our goal is for you to regain the most beautiful smile you can have – and keep it forever!
“The staff is awesome, everyone from the receptionist to the doctor. They make you really feel welcome and address all your issues and concerns. They offer advice on your best course of action and payment plans that work best for you. Great location and the place is absolutely spot less. Lydia is the dental assistant and a real sweetheart. If you have any type of surgical procedure done Dr. V calls you personally the next day to check on you... I recommend this place to anyone.” – Dennis E., Dallas
Some Last Things You Should Know
Here are some additional things I want you to know about how I operate.
1. No Reprimands in the Office
When you make an appointment for your initial consultation with me, no matter how long it has been since you had dental work, I will not scold or embarrass you!
Why some dentists do that is beyond me… I see you as a person and how you are right now in time. There’s no need to dwell on the past, other than to find out what problems you had in the past that contributed to where you are now.
But after that, it’s time to jump onto the track where you get that great smile back that you have wanted for some time. You get the respect from others you deserve and there’s no more discrimination against you simply because you were in the dental hell time warp/black hole.
2. You Choose the Level of Pain You’ll Have in the Dental Chair
And if you have had far too much pain while sitting in other dentists’ chairs in the past, I want you to be comforted in knowing that I use some of the advanced methods of decreasing pain during a dental visit. It’s another of my specialties.
I take pride in this… and my patients have no qualms about booking regular check-ups or cleanings or even fillings because they know I will treat them right.
3. Other Specialized Services are Available
I do want you also to know that I don’t only specialize in dental implants. I offer almost every type of dental procedure that patients need in my office. Most of your dental needs are ones I treat, and include the following:
- Gum Therapy - This includes using dental lasers, plastic surgery for your gums to make them look right, regenerative surgery using bone grafts to rebuild missing bone, and specialized antibiotics to treat resistant gum disease. All these methods are making huge strides in dentistry.
- Advanced 3-Dimensional X-Rays – These are definitely one of the advancements of modern dentistry. The ability to see your teeth in three dimensions is a way of insuring that nothing is missed.
- Wisdom Teeth Removal & Extractions – Impacted teeth cause a lot of pain and can get infected.
“I absolutely cannot express how awesome my dental visit was! The office staff was AMAZING! Dr. Vadivel was so patient and explained everything to me in full-detail! My extraction was done before I knew it! I couldn't believe it! I will forever be a patient to Dr. Vadivel and will refer all my family and friends!! Very affordable!! GET THERE FAST!!! “ – India S.
- Cosmetic Dentistry – Teeth whitening, correcting crowding or alignment problems, applying veneers or crowns to craft a more uniform-looking, bright smile. Achieving your best possible smile
- Same Day Dentures for Missing Teeth Replacement
- Emergency Dental Treatment
“Same day emergency service folks. Great experience and healed up quickly.” – Alicia W.
- Laser Gum Treatment – Laser gum treatment gives results that are similar, if outh for mysterious sores, spots, lumps or bumps that could be cancer. Finding cancer early on is much better than finding it in the later stages. We screen for oral cancer.
- Sedation Dentistry – Fear and anxiety about dental procedures is understandable when you have had a history of pain experienced in the dental chair. However, dentistry has advanced light years and knows now how NOT to cause pain. If you fit in this category, we have different levels of sedation we can choose from, ranging from minimal sedation where you are relaxed and conscious to IV sedation.
“I had a major surgery done here and was a little scared at first. Dr. Vadivel and his nurses made sure I was comfy and ready. I had no issues with the surgery and almost no pain after. I've already handedout his card to multiple people and would recommend him to anyone. My surgery went great and in no time I'm gonna have my smile back. Thank you, Dr. Vadivel and all your nurses.” – John T.
- All-on-Four Dental Implants – This has been explained in this special report. You don’t always need bone grafting with dental implants. With this technique, you won’t. The benefits of these are decreased cost, same day teeth, ease of maintenance, drastically improved aesthetics, potential for eating steak and other difficult foods after the procedure, and great clinical results.
- Pin Hole Surgery – This type of surgical treatment for gum recession is done without scalpels, stitches and grafting. You have less discomfort during the procedure, and can expect faster healing time.
Why not make the decision today to get your bone grafts done professionally by Dr. Vadivel? Give him a call now and make an appointment to start your healing journey. Call his office at 214-304-7561.
Q: How common is the bone grafting procedure?
A: Every year in the U.S., about 500,000 bone graft procedures are performed.
Q: What types of conditions could benefit from bone grafting besides those with jawbone necrosis or jawbone resorption?
A: Bone grafting is used during spinal fusion surgeries. It’s also commonly used during surgeries that remove different types of cancer.
Q: Is a bone graft a replacement for screws to hold bones together?
A: Bone grafts are used to provide strength and stability to the area involved. The goal is to strengthen the area so much that screws and additional surgeries are not needed later.
Q: What are the advantages and disadvantages of a graft that uses one’s own tissues?
A: Bone can be harvested from your iliac crest, and if so, then you will have 0 biocompatibility problems. However, there’s a limited amount of bone you can get from this part of the body. The procedure involves a second surgery, which has an additional cost and causes stress, potential complications, and possible side effects.
Q: What are the advantages and disadvantages of allografts or xenografts from cadavers?
A: These may be easier to obtain; however, they may not be biologically compatible with your body. These bones can be obtained from the Tissue or Bone banks. These bones must be processed in laboratories to make them sterile and safe.
There’s also a possibility that these bone grafts may be infected with a microbe of any type, which is transferred to you. In addition to humans, bones could also be obtained from animals, called xenografts. The animal often, in this case, is a cow. This grafting material also requires laboratory processes to make it safe.
Q: Are synthetic bone graft materials the best bet?
A: Synthetic bone graft materials may work, depending on compatibility of the tissues. If there’s a match, that’s great. As long as the materials bond to the adjacent bone, you have found a great option. One type of material, called bone morphogenic protein is a protein that actually stimulates the bone cells to regrow bone exactly where it’s missing. You might want to check out this video for more information on the topic: . https://youtu.be/p-G8dEM-9g8
Q: What is a dentin graft?
A: This is a less commonly used grafting material. It’s the dentin bone, that is, the bone obtained from the extracted tooth. The tooth has to undergo several clinical as well as laboratory procedures before it could be used as a graft. The grafting material is used in different physical forms – as powder, granules, putty or gel, which could be injected with the help of a syringe.
Q: How much pain is there with bone grafting?
A: You can expect a few days of soreness. There’s very minimal discomfort postoperatively.