Plasma with richer growth – Bone Grafting
What is bone augmentation?
Bone augmentation is the procedure to restore the maxillary bone. Sometimes, when people lose their teeth due to gum diseases, tooth decay, or accidents, it can cause atrophy or bone reabsorption.
The bone in the upper jaw, where the teeth were located, may lose width and height. If the teeth are missing for a long period of time, there is a higher chance of bone loss. The mandible bone atrophies.
The face will become “sunken” and speech changes will occur. Despite technological advances in implantology, it is not possible to place an implant without the right bone density, because there will not be sufficient stability.
Why bone loss occurs?
Over time, the missing teeth will cause bone atrophy on the mandible or maxilla. Aging and systemic diseases contribute to the decrease of the number of bone cells.
After a dental extraction, there will be bone reabsorption on the tissues surrounding the bone and gum. This bone reabsorption may damage the final aesthetic and implant placement due to the lack of support to fix them. Bone regeneration repairs flaws and fills in the space left by bone loss.
What is bone grafting?
Bone grafting techniques were created to overcome this anatomical and physiological limitation. Grafting surgery enables bone regeneration.
This technique will improve the success rate regarding the width and height by filling in the empty spaces and correcting anatomical flaws. Bone growth allows for the safe placement of compatible bone implants. On these grafts, membranes of synthetic or autogenous bone and plasma with richer growth factors are used to speed up the procedure.
What are biomaterials?
They are materials that repair or replace missing tissues. These biomaterials can be natural or biosynthetic (made in a laboratory) and are compatible with the human body.
There are various brands on the market, however, we highlight Geistlich biomaterials fabricated in Switzerland and belonging to the Pharma Geistlich Group. For many decades, this company has been the worldwide leader in products of bone, cartilage, and tissue regeneration. It is mainly engaged in developing products and medication that improve patients’ quality of life.
Through the use of its biological medications, the regeneration processes of the human body are stimulated and repaired. Implantology is possible even in cases of severe bone loss.
Geistlich is one of the pioneer companies to introduce biomaterials in the medical field, developing them in a targeted and responsible way. The company directors believe that the quality of the materials and the patient’s safety should always come first. Therefore, they strongly invest in state-of-the-art technology and intensive training of their employees.
These biomaterials enable the dentist to perform bone grafting and sinus lifts. Thanks to their similarities with human bone and its highly porous structure, blood vessel formation occurs (angiogenesis).
What are plasma-rich growth factors?
Plasma-rich growth factors will speed up bone regeneration. They also contribute to quickening the healing process and making the surrounding tissues grow faster.
There are various ways to obtain platelet-rich plasma. These procedures separate and concentrate the blood platelets and their growth components.
Blood is of the utmost importance to human biological function. Approximately 50% of it is comprised of cells, erythrocytes, leukocytes and platelets. The other half is a yellowish and aqueous liquid with mineral salts, proteins, sugar and fat. Platelets are small and non-nucleated fragments, which have a high quantity of growth factors.
The use of growth factors is considered a breakthrough by several authors of general practise. In particular, dentistry uses this to correct bone flaws, alveolar ridge augmentation, bone grafting, and sinus lift.
What are the benefits of using plasma-rich growth factors?
- The plasma has positive effects on the healing process in terms of the quality and quantity.
- It promotes fibroblasts and osteoblasts function.
- It also promotes growth factor acceleration in others cells, such as macrophage.
What are the techniques to collect platelet-rich plasma?
A vacuum system uses 5 ml tubes to collect blood with an anticoagulant solution. After the tube’s centrifugation, the blood is separated into three basic layers; red blood cells comprise the bottom layer, platelet-rich plasma forms the middle layer and platelet-poor plasma is on the top layer on the tube. The process to obtain the platelet-rich plasma takes up to 20 minutes and is applied on the affected area during surgery.
What are the possible risks or adverse effects of this procedure?
The patient’s choice is based on the absence of local or systemic diseases that can undermine the treatment. Potential contraindications include severe hypovolemia, myocardial ischaemia, unstable angina, coronary disease, sepsis, and others. There is no risk of infection or disease transmission.
Conclusion about growth factors:
The method to obtain platelet-rich plasma is simple and can be done as an outpatient procedure. No specialised personal or specific material are required. It is affordable and the preparation is fast and simple.
Biomaterials – Bone Augmentation
Bone grafting materials
The membrane used in our clinics is absorbable during healing time and is made of collagen. It is recommended for filling bone flaws, empty space left by sinus lift, and the alveolar bone. The membrane is carefully fixed, using surgical sutures.
This is bone material taken either from the mouth or from other areas, such as the hip bone. The patient is both the donor and recipient. In the first case, it can be done in a clinic with local anaesthesia. In the second case, it can only be done in a hospital with general anaesthesia and a multidisciplinary team. This is not a common procedure due to the additional costs.
Implantable ceramic, which is partially absorbable. It has geometrical shapes and granules designed to fill and restore a bone gap. This material has an alveolar structure, enabling an interconnection between pores. The production process removes the infectious contamination risk due to high temperatures during the vitrification stage. It has no biological substances.
What is a sinus lift?
People who have lost teeth in their upper jaw, particularly the back teeth, generally present low bone density, because the bone begins to be reabsorbed and the sinuses are too close to the jaw.
Sinus lift is an oral surgery and implantology procedure that adds bone to your upper jaw in the area of your molars and premolars. It will subsequently enable placement of the dental implants. These procedures are used to correct low bone density.
The maxillary sinus, the largest of the paranasal sinuses, is an air-filled space and also the closest to the molars of the upper jaw. Sometimes, there is direct access to the jaw bone and oral cavity.
The first step in the sinus lift procedure is to make an incision into the gum tissue surrounding the molars and premolars. Next, the adjacent tissue is lifted. The bone is exposed and a small “window” is opened in the bone. Usually, it is possible to see the membrane covering the sinus. This membrane is gently pushed up and biomaterial is then packed into the space. Once the bone grafting is in place, the gum is placed in the correct position and is closed with stitches.
People who have lost teeth in their upper jaw, particularly the back teeth, generally present low bone density, because the bone begins to be resorbed and the sinuses are too close to the jaw.
Are there any risks with this procedure?
The sinus lift technique is widely used and has produced excellent results. However, it is by no means risk-free. For this reason, only qualified health professionals should perform this procedure.
Conclusion about sinus lift and bone augmentation:
Only experienced health professionals should perform this procedure. Since it is not risk-free and complications may occur, the dentist should know how to diagnose and solve arising issues. Usually, there are excellent results in increasing bone density on the upper jaw.
Latest update: April 3, 2021
Nyman S, Karring T. Regeneration of surgically removed buccal alveolar bone. J Periodontal Res 1979;14: 86-92. Park SH,Lee KW, Oh TJ, et al. Effect of absorbable membranes on sandwich bone augmentation. Clin Oral Implants 2008.