Implementation of a jawbone reconstruction
There are various methods available to the oral surgeon for building up the jawbone. The bone material can be introduced by horizontal/vertical augmentation using a bone block. Bone splitting (alveolar process splitting) is another option.
Bone spreading (alveolar ridge spreading) and distraction osteogenesis (pulling the bone apart) are further possibilities. The socket-preservation technique and internal (or external) sinus lift are also used in a variety of patients.Jaw bone augmentation by horizontal or vertical augmentation, medium jaw block is the most frequently performed procedure. It is particularly suitable for patients in whom the bone loss is particularly advanced.
In the course of this procedure, both endogenous bone (autogenous bone) and donor bone (allogenous bone) can be used. After opening the gums and preparing the remaining bone, the selected material is inserted into the areas to be treated and fixed with small titanium nails or screws. In so-called bone splitting (alveolar process splitting), the residual bone is split in the middle using a cutting disc.
The two halves are then completely separated from each other using a hammer and chisel. In most cases, the surgical site must be provisionally closed for the time being and the bone replacement material inserted a few days later, but in some cases the jawbone can be rebuilt immediately. The surgeon inserts the selected replacement material into the cavities created by the bone division and mixes it with the body’s own blood.
The treated area can then be closed again with a gum suture. A jawbone reconstruction is usually performed under local anesthesia. In exceptional cases an anaesthetic may also be considered.
Is there a difference between upper and lower jaw bone augmentation?
Bone structure is not equal to bone structure and is strongly dependent on the side of the jaw. The upper and lower jaws have very different structures due to the anatomical bone structure. In the lower jaw the bone substance is rather dense and hard, while in the upper jaw the bone substance is rather honeycombed, porous and softer.
The bone in the upper jaw is therefore often weaker. In addition, the bone in the lower jaw usually tends to lose height when bone is lost, while in the upper jaw it first loses width and then height. For this reason, a larger bone level often has to be restored in the upper jaw than in the lower jaw.
In the lower jaw, the inferior alveolar nerve is also anchored in the nerve canal within the bone. This nerve channel is potentially endangered during surgery, making it even more difficult. It is also decisive whether bone width, density or height is to be restored or expanded, since bone width is largely less problematic to restore than bone height.
