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Bone grafting is a surgical procedure that uses transplanted bone to repair and rebuild diseased or damaged bones. A bone graft is a choice for repairing bones almost anywhere in your body. Your surgeon might take bone from your hips, legs, or ribs to perform the graft. Sometimes, surgeons also use bone tissue donated from cadavers to perform bone grafting.
Most of your skeleton consists of bone matrix. This is the hard material that helps give the bones their strength. Inside the matrix are living bone cells. These make and maintain this matrix. The cells in this matrix can help repair and heal bone when necessary.
When you break your bone, the healing process begins. As long as the break in your bone is not too large, your bone cells can repair it. Sometimes, though, a fracture results in a large loss of bone, like when a large chunk of the bone crumbles away. In these cases, your bone might not fully heal without a bone graft.
During a bone graft, your surgeon inserts a new piece of bone in the place where a bone needs to heal or join. The cells inside the new bone can then seal themselves to the old bone.
Surgeons often perform bone grafting as a part of some other medical procedure. For example, if you have a bad fracture of your thighbone, your healthcare provider might perform a bone graft as part of other necessary repairs on your bone. Your healthcare provider might make an incision in your hip to remove a small piece of your hip bone, using that to perform your graft.
In some cases, an artificial material is used in a similar way, but this is not a bone graft in the traditional sense. You will typically be put to sleep with general anesthesia for the procedure.
You might need bone grafting to promote bone healing and growth for a number of different medical reasons. Some specific conditions that might require a bone graft include:
These bone grafts can provide a framework for the growth of new, living bone. Hips, knees, and spine are common locations for bone grafting, but you might need bone grafting for a different bone in your body.
Talk with your healthcare provider about whether you want to use a bone from a donor or a bone from elsewhere in your body. If you use your own bone, you will have to have extra surgery to remove this bone. You won’t need this if you use donated bone, but donated bone has its own small risks. Talk with your healthcare provider about what makes sense for you.
Bone grafting is generally safe, but it does have some rare risks.
There is also a risk that your bone might not heal well even with your bone graft. Many of your specific risks will vary according to the exact reason for your bone graft. These reasons include whether or not you are using donor tissue, your other medical conditions, and your age. For example, your bone graft might not be as likely to heal well if you smoke or if you have diabetes. Talk with your healthcare provider about all your concerns, including the risks that most apply to you.
Talk with your healthcare provider about how to prepare for your bone graft surgery. Ask whether you should stop taking any medicines ahead of time, like blood thinners. If you are a smoker, try to stop smoking before your procedure to help speed healing. Tell your healthcare provider about all the medicines you take, including any over-the-counter medicines like aspirin. Also, tell your healthcare provider about any changes in your overall health, like a recent fever.
Before your procedure, you may need additional imaging tests, like X-rays, CT scan, or magnetic resonance imaging (MRI).
You may need to make additional arrangements ahead of time, depending on the reason for your bone grafting. For example, if you won’t be able to put weight on your leg after your surgery, you may need to rearrange your living arrangements.
Do not eat or drink after midnight the night before your procedure.
The details of your bone grafting surgery will vary a great deal according to the reason for your surgery. Ask your healthcare provider about the details of your particular surgery. An orthopedic surgeon will perform your procedure aided by a team of healthcare professionals. As an example, you might expect:
Talk with your healthcare provider about what you can expect after your surgery. You may have some pain after your procedure, but pain medicines may help to relieve the pain. You should be able to resume a normal diet fairly quickly. You may get some imaging, like an X-ray, to make sure your surgery was successful. Depending on the extent of your injury and your other medical conditions, you might be able to go home the same day.
Your healthcare provider will give you detailed instructions about how you can move the area that received the bone graft. This usually involves keeping the area immobile for a while. This might require a splint or a brace. You’ll also probably need to avoid putting weight on the area. You may need physical therapy to restore strength and flexibility to your muscles.
You might need to take medicines to prevent blood clots (a “blood thinner”) for a little while after your surgery. Your healthcare provider might not want you to take certain over-the-counter medicines for pain, because some of these can interfere with bone healing. Your healthcare provider may advise you to eat a diet high in calcium and vitamin D as your bone heals. If you smoke, your healthcare provider may also advise you to stop smoking, because this may interfere with bone healing.
You might have some fluid draining from your incision. This is normal. But, let your healthcare provider know right away if the draining is severe. Also, let your healthcare provider know if your wound has increased redness or swelling, or if you have severe pain, loss of feeling, or a high fever or chills.
Make sure to keep all of your follow-up appointments. You may need to have your stitches or staples removed a week or so after your surgery. Your healthcare provider may want to perform a series of X-rays to see how well your bone heals. Follow all your healthcare provider’s instructions carefully to have the best chance at full recovery.
Before you agree to the test or the procedure make sure you know:
Alveolar bone is a hard connective tissue that holds the roots of teeth (alveolar ridge) and supports the gingiva. Normal bone is always remodeling and old bone is constantly being replaced by new bone. When teeth are present in the alveolar bone, they sustain bone remodeling. When teeth are lost or bone physiology is affected by disease, the remodeling process is disrupted and the alveolar bone decreases in volume.
Bone grafting is a surgical procedure where the clinician replaces your missing or inadequate bone volume with biomaterials of different sources. The procedure involves placing these materials in contact with bone to augment its dimensions. This allows for successful implant osteointegration in the future.
Some instances when grafting is necessary :
– Following tooth extraction, in order to maintain the dimensions of the alveolar socket.
– For “sinus augmentation” procedures. Sinus augmentation procedures are performed in cases that require additional bone in the vertical direction in the posterior region of the upper jaw. The placement of an implant without sufficient bone in this area would cause the top portion of the implant to come in contact with the interior of the sinus causing irritation and inflammation. The area with insufficient bone is replaced with graft material.
– For “lateral ridge augmentation” procedures. Cases with insufficient bone surrounding the implant site require the use of graft material placed in all horizontal directions so that 2 mm of future bone is obtained prior to implant placement.
Following tooth extraction a clot forms inside the tooth socket. In time, this clot remodels leaving behind bone. During the remodeling process the clot shrinks and the resulting bone height and width will decrease. Replacing missing teeth with implants is the most common procedure. Successful implant osteointegration and esthetic outcome are dependent on bone availability prior to implant placement. Bone grafting procedures aim to restore the alveolar bone to suitable dimensions in order to support a future implant.
An autograft involves bone collected from other parts of the patient’s body. This type of graft has the possibility to induce bone formation with no host response from the patient’s body. The main disadvantage with an autograft is that it requires a second surgical site that can lead to additional pain, infection and bone related complications.
Allograft bone is bone collected from another patient or cadaver. It eliminates the need for a second surgery; however, there is a chance of disease transmission from the donor. Since allografts lack protein components due to sterilization, the healing time is increased. The most common allograft in use is Demineralized Bone Matrix (DBM). Many studies have reported contradictory reports on its efficacy. The quality of the donor bone can cause variability in the material. Xenografts are graft materials obtained from animal bone.
Synthetic alloplast materials have been developed to confront the issues brought on by the other types of grafts. Alternative materials can be ceramic-based (calcium phosphates, calcium carbonates, calcium sulfates), natural or synthetic polymers. Growth factors can be added to these materials in order to mimic the properties of autografts. Calcium sulfate-based materials are inexpensive, biocompatible and resorb completely leaving behind native bone. Calcium sulfate stimulates the formation of blood vessels, which provide nutrition for growing bone. Calcium sulfate can be used alone or in combination with other graft materials, drugs or growth factors.
Synthetic materials aim to mimic bone structure and composition. Ceramic-based materials are used for their similarity to bone mineral, a component that provides mechanical support and acts as a matrix for bone cells. They can act as carriers for growth factors or drugs. Their resorption rates can be modified to allow for a more rapid or slower dissolution, depending upon which procedure is used. There are no risks for disease transmission with synthetic materials, and they eliminate the need for a second surgical site.
Bone regeneration refers to instances when a material used to fill a bone defect resorbs completely and stimulates new bone formation.
Bone replacement refers to cases where a bone defect is filled with a material that does not resorb, filling the space without stimulating new bone growth.
It is important to have direct contact between host bone and the implant, as implants placed in native bone have higher rates of osteointegration and success. It has been shown that the higher the bone-to-implant contact, the higher the success rate.
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