Implantología dental avanzada y estética facial. Advanced implantology & facial aesthetics. Dr. Pablo Furelos.
One of the main problem when placing dental implants is the lack of a proper support for them in certain areas.
That is when we are informed we have little bone.
Several techniques have been designed to avoid those maxillary areas with little bone, even placing the supporting pillars for the denture in an inadequate inclination, and resigning to place enough of them.
But this is quite far from an ideal result, and mainly it hasn’t expectations for being long lasting.
It is necessary to place enough dental implant, in the right position and the right verticality.
Bear in mind that the goal is not having denture today. The goal is that it remain there as long as possible without any problem.
Logically, to have a proper osseous support in adequate places is necessary to replace the bone where needed.
The reposition of the lost bone is done by using bone graft.
It is also logic that the ideal solution to replace that loss is the usage of autologic bone, obtained from some part of the patient’s body. But this means an additional surgical intervention, in some occasions of great magnitude.
That is why new techniques with materials that have shown their reliability, have been developed.
Our body’s bone is a dynamic structure, fruit of a balance between cells that are continuously working to build (osteoblasts) and cells that reabsorb (osteoclasts). The balance between both depends on various factors.
Certain bones stand a considerable dynamic load and this determines their density; among them, the iliac bone and the rib. That is why astronauts suffer the losing of bone mass (50% in some occasions) due to a lack of exercise. That happens with those bones when they are immobilized in a new position, something that we do when we use them as graft.
There are some bones such as the skull, with a different composition that, when they are adapted to the lack of muscular stimulation, undergo less reabsorption when are used as graft and stand still. This is why cranial bone grafts are more predictable than others, undergoing less reabsorption.
But like any surgical technique, sometimes there is failure. And after general anesthesia, some days of admission and a more or less long convalescence, this failure is seen like an absolute drama.
It is not surprising that many patients resign to the placing of dental implants if the only opportunity they are offered is the obtaining of these grafts, even when they think everything will go right.
That’s why we have been constantly looking for a possibility to obtain a substitutive for the autologic bone (from the patient), that we will call powdered bone graft as a way to differentiate them.
Powdered bone graft, a transcendental change in dental implantology.
This constitutes the great advance of implantology in the 21st century. With adequate techniques, very strict surgical protocols and always under local anesthesia it is possible to replace the bone under any circumstance expecting it to last long.
This together with other innovations such us the usage of platelet concentrate , short implants,…have managed, to little by little, left aggressive techniques in favor of these innovations.
Clearly there is failure in some occasions, but less than 5% of the cases. But as the procedure has been simple, quick and painless, that is with no personal costs, we can call this failure an uncomfortable incident. And it is reversible, you can always try again and it is normally successful.
This is something that happened to us many years ago. Our las hip bone graft (iliac bone) was made in the year 1999.
The last skull bone graft was in 2001, as we have alternative techniques that equal or even better in reliability.
In this period we haven´t rejected any patient for being inoperable. This is very significant if we take into account that we receive patients of medium and maximum difficulty.