I have had two dental implants put in about 4 months ago after missing my two bicuspids for several years. Gums have shrunk severely, however on the day of the procedure the periodontist decided bone graft is not needed. It has now been almost 4 months since the surgery and he is suggesting bone graft. Is it okay to have bone graft added after implants have already been placed? Is it going to be an issue to open the gums back again and would it take an additional 6 mo. for healing to take place?
Is It Normal for Bone Graft to Be Added 4 Months After Dental Implants Have Already Been Placed?
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Bone grafting after dentall implants placement
I assume the reason to decide to do bone grafting now is because of gum tissue recession or inadequate bone covering the implant. The question is why this has occured? Inadequate bone to begin with where the bone was too thin? inflammation / infection process? or excessive bone remodeling. Typically, with proper thickness of bone at time of placement, unless infection occurs, it is very rare to need additional bone graft later. Whatever the reason, if there is no bone covering the implant, a second bone graft can be done. While it is possible, they are less predictable and tissue management is critical in its success. The gum tissue does require to be openend again and yes, it is going to need additional 4-6 months of healing before it is re-assessed.
Bone Graft After Implants
Adding a bone graft post implant placement can be predictable as long as the surgeon has realistic expectations. In some cases after implant placement we are observing in patients with thin tissue which routinely associates with thin bone that we get some resorbtion of the bone. In that case in order to preserve the existing bone we will place a slow resorbing bone graft material to protect the implant. That being said we ususally try and plan that at the time of implant placement as that is the most predictable time to place the bone. But the body heals in very different ways and heroic dentistry sometimes need to be preformed.
Have your surgeon discuss with you:
1)why he is placing a bone graft?
2) what bone graft he is using (human, synthetic, bovine, Combination)
3) What he wants to achieve
4) success rate
5) possibility of more bone loss from opening the "flap"
Bone graft after 4 months is ok.
When a tissue is traumatized, the body responds. When bone graft material is placed on the day of an extraction, the cells that go in to respond to the trauma will help create new bone. Four months after a procedure is done, the bone doesn't have the same stimulus to create new bone. There are newer procedures coming out that increase the probablity that bone will grow, which include adding platelets from the person to the bone mix. The reason you would want to grow more bone is for additional strength to support the implant.
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Bone Grafting Shortly After Implant Placement
One concept that must be understood is that whenever gum tissue is reflected (i.e., opened with an incision) and bone is exposed to the environment, some amount of bone loss will occur. The decision to add bone shortly after implants have already been placed means one of two things:
- The implant threads are exposed
- The gum tissue ridge above the implant is deficient
If the implant threads are exposed, adding bone will be highly unpredictable. Research has shown that this technique may only add a very slight amount of bone (less than 1.0 mm) but only in the most skilled hands. If the gum tissue ridge above the implant is deficient, adding bone may help "plump" out the ridge so as to prevent food collection and for esthetic purposes. It would be wise to consult with your dentist and ask the reason why he/she is considering this procedure.
A bone graft sometime after an implant is placed is not normal.
Although a bone graft can occasionally be place successfully after an implant is placed, this is not a predictable procedure. If there has been any exposure of the implant with the mouth via a small or large opening or if there is any bacterial contact or infection the chances for success are not good. There are a great many factors that may effect the outcome in a situation like you have described and it would not be a bad idea for you to get a second opinion from an experienced oral surgeon who routinely places implants.
Dental Implants and Additional Bone Grafting
While not typical to add bone after implant placement it sometimes is necessary.
Reason can include part of the implant threads are no longer in bone and need to be covered.
Recession of the gum tissue.
Infection that has erroded the surrounding bone.
Yes the gum tissue is going to need to be pushed back to expose the implant, new bone material placed and then the gum will be closed around the bone graft and implant.
Typical healing times will be 4 - 6 months for the grafted bone to turn into living bone.
All the best with your case.