Implants or preprosthetic surgery

This is often a difficult choice for the patient.

Suppose you lose a tooth. The best solution would be to have a new tooth. However, transplanting teeth is only possible as long as the root of the tooth has grown for a maximum of two thirds, i.e., approximately until the age of 18 at a maximum.

Afterwards, only a bridge can be made. The dentist will reduce the teeth on either side of the missing tooth and install a bridge. The fact that two teeth are reduced and that the maximum life of a bridge is limited to 10 years are huge disadvantages of this procedure.

The best solution is to place an artificial root (read: implant) on which the dentist installs a crown (read: visible part of the tooth) four months later.

In the latter case, there must be enough “fundament” (read: bone) present. And that is where the problem usually lies.

Due to earlier inflammations or due to removal of the tooth, the bone has often disappeared. As a result, this fundament has to be reconsolidated.

We try to imitate nature as closely as possible.

Placing short implants (roots) usually means installing large crowns. The force of chewing often tests these constructions. The ratio is: 1/3 crown – 2/3 root.

Therefore, we first try to optimize the “fundament”, if necessary, to be able to insert a correct implant afterwards in order to obtain a good result in the long run.

Bone grafts can be taken from various places depending on the amount of bone we need and on the type of implant.

If we need only a small amount of bone, allografts (type Bio-Oss®) are most commonly used. This is freeze-dried, ground bone of selected cows from New Zealand (no mad-cow disease!) with all of the protein and cell growth removed. Only the bone “grid” is used for your cells to grow in (the bone is delivered in tubes of 0.5 g or 2.0 g).

Anterior hip crest graft

Bone taken from the front of the hip crest bone is ground and adapted to the “acceptor bed”. This bone transplant is used to reconstruct medium-sized defects and is fixed by micro-osteosynthesis (small screws).

This procedure relates to a patient’s personal material with growth potential and resistance to infections; the patient only has a small scar of about 3 cm at the “bikini line”.

Dorsal hip crest graft

Bone taken from the back of the hip crest bone.

This option is usually considered for reconstruction of large defects, e.g. the construction of a complete upper and/or lower jaw.

This operation causes some difficulties when walking and jogging for about 10 days. The hip joint is left untouched. Muscles on the bone structure are “slid off” and then attached again, which causes the stiffness and the “pulling sensation” the patient feels when walking during the first days after the operation.

Calvarium graft (bone from crown of the skull)

This is an alternative to dorsal or anterior hip crest.

The crown of the skull consists of two layers of hard bone material (cortex) of which only the outer layer is removed so that the strength of the skull remains intact. An incision must be made in the hairy skin of the head which could be a disadvantage in case of (impending) baldness.