Dental Bone Regeneration - Everything You Need To Know

Dental Bone Regeneration

The process of dental bone regeneration is a method that utilizes bones from different sources to make new bones for jaw. This is crucial because if there are no tooth roots to connect a particular element of your jaw, the bone is likely to shrink. Depending on the kind of bone graft (autograft, allograft, xenograft or alloplastic) to be used, the patient can expect one or more methods for grafting which may have a short healing or a longer time in recovery. 

The jaw’s edentulism and the periodontal issue are both conditions that could destroy an alveolar bone. The loss of teeth and bone that supports the alveolar bone may result in maxillary atrophy or deformities of the crest. Restoring functional health requires implants with an endosseous structure. They require sufficient bone mass to keep the masticatory pressure. In these situations, bone needs to be repaired with the help of the biological principles that underlie osteogenesis, osteoinduction, and osteoconduction. Different techniques employ these principles with varying results due to the bone base to be worked upon, the procedure decided to be performed, and the condition of the bone metabolism. 

The various reasons for a weak jaw bone can be addressed through procedures based on biochemical factors that regulate the process of bone growth.

What Does Bone Regeneration Treatment Entail? 

Induction of osteogenesis and osteogenesis have biological concepts that help us restore the volume of bone loss. 

The first allows the autologous bone to be utilized: osteoblastic cells and haversian mechanisms in the bone fragments grafted are replaced with newly formed bone from the walls of the graft bed recipients[1]. The osteoinduction process allows for the expansion and migration of connective cells, which are not differentiated at the area to be renewed. This possibility of differentiation is by growth factors (GF) on the site[2]. 

The term “osteoconduction” refers to the capacity of a substance to function as a structure that aids the healing of tissue. The material is also able to be partially replaced by new cells[3]. 

Different methods allow the application of the principles. The results from the grafting process can differ in terms of the quantity, quality, and the grafting method used. In actual reality, within the jaw bone are three methods that can be used to repair bone: repair, regeneration, and guided repair[4]. 

The repair occurs in the connective tissue formed by fibroblasts and cells. These cells will then replace osteoblasts. They then create an osteoid matrix that expands and ossifies[5]. However, the amount of tissue being regenerated is less than expected because of non-osteocompetent cell interference[6]. 

The guided repair uses the resorption/substitution of an osseointegrated biomaterial with new bone. The final result will depend on the characteristics of the osteoconductive grafted material and create tissues in which tracks of that same material will remain for a long time[7]. Regeneration is limited to applying undifferentiated connective tissue present within the area to be rejuvenated by suitable treatment options that will isolate the site or, to bone formed from an autologous vital material inserted in the defect[8]. 

Pros and Cons of Bone Regeneration Options 

The process of bone regeneration after the grafting procedure allows for the growth of bone and tissues around the periodontal cavities site. By using Plasma Rich Growth Factor (PRGF), the healing process is accelerated. 

The most significant drawback of the procedure is that its success depends on the patient. Good oral hygiene is required to be maintained so that infection is unlikely to return, and the treatment turns successful. 

The complete healing process requires approximately six months and owing to the long and extended time to entirely heal, the chance of failure is higher when patients do not adhere to the proper procedure. 

A few aspects which are crucial for the successful process of bone regeneration: 

Closure of primary wound: 

• Angiogenesis functions as an organ for circulation and also the source for undifferentiated mesenchymal cells 
• Space maintenance lets the tissues of the periodontal to develop 

Wound’s stability: 

• While non-surgical periodontal treatment and the standard endodontic treatment are effective for treating mild to moderate imperfections, they may not be enough to treat the condition of the endodontic tooth. 
• Conventional surgical techniques provide more patients, but they have an advantage since healing tissues is likely to be the primary outcome. 
• Another factor to consider when choosing the type of bone graft procedure, you will receive is the substance from which the bone graft is made. Each bone implant material has its advantages and disadvantages, depending on your preferences and circumstances. 

Autograft 

Autografts are where the doctor uses bone from another location within your body to assist in the development of new jawbone. This bone may be taken from your jaw, hip or tibia. 

The advantages of having an autograft include: 

• There is less chance that your body will oppose the bone during the transplant. 
• Dentists can remove bone from nonessential places. 

The disadvantages of an autograft include: 

• Another surgical site as well as a procedure. 

Allograft 

An allograft is made up of bone given by a donor. This kind of bone typically comes from a bone bank and is implanted similarly to autografts. 

The benefits of an allograft are: 

• There is no other surgery website or surgical procedure that is required. 
• Allografts are often used and are readily accessible. 

The disadvantages of an allograft include: 

• Sterilizing the bone can result in a slower graft healing process. 

Xenograft 

A xenograft uses bones from animals that have the same bone structure as the human body. This is typically bovine bones or equine bone. 

Pros of xenograft are: 

• There is no extra operation or procedure needed. 
• The bones of various animals are very similar to human bones. 

Cons of xenograft include: 

• Certain patients might not be comfortable with animal bone. 

Alloplastic 

A graft made of alloplastic is made of synthetic substances to encourage the development of bones. Alloplastic grafts typically contain glass, which is composed of minerals naturally found in bones, making them suitable for patients and effective in bone regeneration. 

The benefits of alloplastic grafts are 

• There is no other surgery website or surgical procedure necessary. 
• There is no chance of disease transmission through bone. 

The drawbacks of alloplastic grafts include: 

• There is a minimal chance that the graft might be rejected by the body. 

What To Expect During Bone Grafting 

Before undergoing the procedure of dental bone graft replacement, it is essential to evaluate the health of your teeth through an oral examination. This is performed to determine the extent of bone loss that has occurred. The dentist will then review your options for treatment and formulate the best plan to meet your needs and health requirements. 

Local anesthesia and creating the incision: 

The surgical location region will be numb after applying a local anesthetic and making a small cut through the gums. After the administration of local anesthesia, and after an incision has been made, then your gums would be moved back slightly to expose the jawbone. This ensures that you are comfortable and would not experience any discomfort during the treatment. Additionally, if the graft components are to add from a different area of the body then the necessary surgical location will also undergo anesthesia and an incision. 

Cleaning and disinfection: 

If the jawbone is visible after that, then it will be thoroughly cleaned and the area will be scrubbed to avoid any contamination. This is especially crucial if you have been suffering from gum disease. 

Adding the grafting material: 

The next step requires adding the grafting material. For additional protection, the bone graft might be shielded by a membrane. 

Repositioning the gum tissue: 

The last step to take before completing the procedure is to move the gum tissue. Sutures can be used to support the stability of the graft and to keep the graft from moving. 

How Long Does It Take to Recover From A Dental Bone Graft? 

It is common for patients to experience swelling and bruises around the site where the dental bone has received graft. The swelling is expected to disappear in a matter of days, and pain medications will ease the discomfort. Placing an ice pack on the affected area can help in reducing the swelling. 

Your diet should generally include soft, lukewarm foods or cool liquid. The hard or crunchy foods could cause blockages at the location of the graft and must be avoided until the healing process has been completed. Also, refrain from drinking alcohol and drink plenty of fluids to stay hydrated. The initial phase of recovery takes about two weeks. The process of recovering dental bone grafts is accomplished in two major stages. 

For an effective recovery, follow the below-mentioned steps: 

• Limit physical exercise 
• Consume soft and lukewarm temperature food 
• Start taking antibiotics 
• Utilize painkillers (if required) 
• Make sure you take good care and maintain hygiene of the graft area 
• In case you experience minor swelling or pain, apply ice. 

[1] Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res. 1983; 174:28–42. 

[2] Sykaras N, Opperman LA. Bone morphogenetic proteins (BMPs): how do they function and what can they offer the clinician? Journal of Oral Science. 2003;45(2):57–73. 

[3] Albrektsson T, Johansson C. Osteoinduction, osteoconduction and osteointegration. Eur Spine J. 2001;10: s96–s101. 

[4] Tonelli P, Duvina M, Barbato L, et al. Bone regeneration in dentistry. Clin Cases Miner Bone Metab. 2011;8(3):24-28. 

[5] Cardaropoli G, Araújo M, Lindhe J. Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs. J Clin Periodontol. 2003;30(9):809–818. 

[6] Schropp L, Wenzel A, Kostopoulos L, et al. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiograhic 12-month prospective study. Int J Periodontics ristorative dent. 2003; 23:313–323. 

[7] Lynch SE, Marx RE. Tissue engineering Grafting materials in repair and restoration. Miami Quintessence Books. 2000:84–97. 

[8] Buser D, Bragger U, Lang NP, et al. Regeneration and enlargement of jaw bone using guided tissue regeneration. Clin Oral Impl Res. 1990;1(1):22–32.