The key to choosing the right grafting material in a clinical situation lies in understanding the properties of the graft material, from both a handling and a bone-growth perspective.
The importance of grafting bone for implant dentistry cannot be overstated. The quality and quantity of bone around dental implants sets the stage for both the stability of an implant as well as the soft-tissue architecture around an implant. The interrelationship between bone and soft-tissue support is as important as the soft tissue around a dental implant and is part of what helps maintain an implant’s survival and long-term success.
There are many bone grafting materials available on the market today. The key to choosing the right grafting material in a clinical situation lies in understanding the properties of the graft material, from both a handling and a bone-growth perspective. Every material available for bone grafting has an osseoconductive nature, meaning that the material creates a scaffold for blood cells to infiltrate a graft site to start the bone remodeling and formation process. Only demineralized donor bone or autogenous bone can offer inductive properties to a graft site. If larger areas are being grafted that have less adjacent bone support, then osteoinductive or osteogenic autogenous bone materials become more important. Once a clinician understands the science and properties of graft materials, then better decisions can be made from a material choice standpoint.
From a handling perspective, putty graft materials offer certain handling advantages over particulate materials. DFDBA donor putties offer hemostasis, reduced migration of materials, and easier handling. An alternative to using a bony putty is to mix particulate materials with PRP or PRF growth factors to increase handling and growth potential of the graft materials. This requires the extra steps of ascertaining and processing the blood-derived factors, and then combining that with the graft material.
An example of how grafting can benefit an implant case clinically is when the clinician is placing graft material into extraction sites in full-arch implant supported cases. By grafting extraction sites in full-arch cases (or any extraction case), a more hygienic ridge morphology is created. Compared to a nongrafted arch or site, grafting in this manner allows for a flatter and more cleansable ridge and easier long-term maintenance for the patient. When the pontic area with a full-arch implant-supported case has a convex shape, the prosthesis is easier to clean. Grafting allows for this to happen in a more predictable manner.
In this month’s Implants Today section, we have an interview with Dr. Lee Silverstein, one of our advisory board members, who offers his views on and talks candidly about the main concepts for success with bone grafting. In addition, Dr. Charles Schlesinger’s article discusses the importance of grafting when implants are placed after extractions.
If you have any questions or comments about this topic, or any other subject presented in Implants Today, feel free to contact Dr. Tischler at mt@tischlerdental.com.
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