Bone Grafting, Socket Grafting, Nerve Injuries - Central Maryland Oral and Maxillofacial Surgery, P.A.

Central Maryland Oral and Maxillofacial Surgery, P.A. - Richard Nessif, DDS - Domenic Coletti, DDS, MD

Why do I need Bone Grafting?

Your jawbone is stimulated by your tooth roots; much like exercise stimulates your muscles. When you have missing teeth, your jawbone is no longer stimulated by the tooth roots, and it will shrink over time. When this occurs, there may not be sufficient bone required to place dental implants. Bone grafting is also used to repair supporting bone around your teeth that has been damaged by periodontal disease.

What is Bone Grafting?

Bone grafting is a procedure to rebuild bone in the bone deficient areas of your jaw. This allows for the placement of dental implants and for repair of the supporting bone around your teeth damaged by periodontal disease.

What does Bone Grafting Involve?

The bone used in the bone grafting procedure is either taken from your jaw, hip, or tibia (below the knee), or obtained from a tissue bank. Special membranes may be used to protect the bone graft and promote natural healing and bone growth – this is known as guided bone regeneration.

What are the Benefits of Bone Grafting?

By regenerating bone tissue, patients who previously did not qualify for the placement of dental implants due to insufficient bone, can now become candidates for this tooth replacement procedure.

For patients affected by periodontal disease, bone grafting will repair the supporting bone around your teeth significantly improving your oral health. Bone grafting will also increase the stability and strength and increase the longevity of your natural teeth as they will now be supported by adequate bone in your jaw.

Overall, the functionality of your teeth and your esthetic appearance will dramatically improve.

fig:2 Bone Grafted to Replace Lost or Deficient Bone

fig:3 Dental Implants placed After Bone Regeneration

What is a Socket?

A socket is the area of the bone where the tooth is rooted. When advance periodontal disease or injury has caused extreme deterioration to bones and teeth, the tooth socket may need to be reconstructed.

What is Socket Grafting?

When a tooth has suffered extensive damage or has been lost, it may require socket grafting. Socket grafting is a procedure which rebuilds the bone to allow for tooth replacement by a dental implant or bridge restoration. The bone which surrounds the tooth socket deteriorates very quickly once a tooth is removed.

If a socket continues to be empty after tooth loss, the accelerated bone loss can impact adjacent teeth. Thus, it is incredibly important for appearance and health to rebuild the socket at the time of tooth loss.

What is Involved in Socket Grafting?

If the tooth has not already been removed (see Figure 1), the remaining tooth will be extracted (see Figure 2). All remaining root particles will be removed to leave a clean empty socket. Bone grafting material will then be placed into the socket, which will build it into a firm foundation for reconstruction (see Figure 3). There are several types of bone grafting materials available and Dr. Nessif and Dr. Coletti will choose the appropriate type to suit your needs.

There is an extended healing time for the grafted material to fully combine with your natural bone (see Figure 4). The healing process must be complete before continuing with the restoration. Once the new bone is solidified, implants or bridgework can be implemented to restore full function. Socket grafting greatly improves the chances that the missing tooth site will allow the patient to have a dental implant.

Figure 1: Failed Tooth, Figure 2: Tooth Removed & Area Prepared, Figure 3: Socket Filled With Bone Grafting Material, Figure 4: Natural Bone & Material Have Combined

What Causes Nerve Injuries?

Nerve injuries which supply the sensation in your face, jaws, teeth, gums, lips, or tongue can be caused by trauma, surgery and sometimes dental procedures such as root canal fillings, wisdom teeth removal, insertion of implants, correct jaw deformities, or other procedures. Soft tissue lacerations and facial bone fractures can cause significant nerve injuries. Local anesthetics (such as “Novocaine”) can also trigger nerve injury. Despite the best of care provided, nerve injuries are an inherent risk of any dental or surgical procedure.

How Do I Know if I Have a Nerve Injury?

You may experience a variety of sensations, most of them are unpleasant: numbness, tingling, crawling sensations, burning, hypersensitivity of the affected area, or electric shocks are some symptoms of a nerve injury. These sensations can interfere with normal activities such as chewing, speaking, drinking of liquids, washing, smoking, kissing or shaving and can cause distress to the patient. If these symptoms persist longer than one month following surgery, the nerve injury will likely not resolve on its own without other treatment or surgical intervention.

What are the Different Types of Nerve Injury?

Many types of nerve injury can arise, which include:

•	Compression of the nerve by tooth or bone fragments (see Figure 1), scar tissue, or foreign material such as bone fixation screws, dental implants, or plates or wires.
•	Burns from corrosive substances such as medications or root canal filling materials.
•	Stretching from a traumatic injury or manipulation during surgery.
•	Partial or complete severance of the nerve causing an interruption or discontinuity, or the growth of a neuroma (a mass of nerve tissue that can be quite painful).

Fig:1 Tooth fragment compressing the nerve

What are My Treatment Options?

Depending on the type and severity of injury, one or more of the following procedures can be done:

•	Decompression – the nerve is relieved of any material or tissue pressuring it.
•	Nerve Grafting – the lost portion of the nerve is replaced by a sensory nerve graft taken from either the posterior portion of the lower leg or the neck.
•	Neurolysis – removes scar tissue inside the nerve
•	Suturing – the two ends of the nerve that are severed are held in place with precise stitches.
•	Removal – of any abnormal nerve tissue or a neuroma.

What Factors Maximize the Chance of Recovery?

•	How quickly the surgery is performed after the injury – the best outcome occurs when the injury is repaired within three to six months. Later repair can be successful, if the tissue beyond the injured area has not undergone permanent deterioration.
•	The surgeon’s skill level – Microneurosurgery is a demanding skill. Nerve operations need to be done frequently to maintain skills. Dr. Nessif and Dr. Domenick Coletti possesses microneurosurgery skills and keeps his skills up to date.

After your examination, we will discuss with you the type of nerve injury you have, the possible methods of treatment available, and the best outlook for improved sensation.

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