Tissue Engineering and Regeneration
The four research areas that hold the key to a future of periodontal tissue engineering and regenerative medicine.†
Periodontal disease or tooth loss causes bone loss. As a result, the bone loss generally causes the bone architecture to become deformed. Sometimes this can cause an unattractive indentation. From a treatment standpoint, the bigger concern is that the damaged bone can no longer support natural or artificial teeth. In order for patients to keep existing teeth or support a dental implant, tissue engineering or periodontal regeneration is sometimes required.
Periodontal tissue engineering and regeneration has yielded advances in the formation of new periodontal tissue (cementum, periodontal ligament and alveolar bone). Periodontal regeneration can literally change tooth prognosis and survival for both the immediate future and long term. In fact, emerging and established long-term studies* on the survival rate and incidence of complications of natural teeth treated with periodontal regeneration show results that are comparable to implant treatment options.
Sinus augmentation is a surgical procedure where the available bone height is modified in a patient’s posterior (molar region) upper jaw (maxilla) to make the bone tall enough to withstand the safe placement a dental implant. It is one of the most predictable and well-researched therapies in implantology. Sinus augmentation may be performed several months prior to, or concurrently with, implant placement. When properly executed, sinus augmentation improves implant outcomes and is not detrimental to the health or function of the maxillary sinus.
Like sinus augmentation, ridge modification is a surgical procedure where bone augmentation is performed – in this instance to widen the bone (horizontal augmentation) or increase the bone height (vertical augmentation) in the region of either the upper or lower jaw. The areas where bone width is modified are the sites which used to contain the tooth sockets. Alveolar atrophy as a result of tooth loss can leave patients with inadequate bone in which to place dental implants. Using modern guided bone regeneration principles and techniques, ridge augmentation creates normal contour and volume, allowing for implant placement in optimal prosthetic positions.
Following the loss or extraction of a tooth, there is a natural and unavoidable resorption phenomenon that occurs in the dentoalveolar process (tooth socket). This results in ridge deficiencies, which can complicate future implant placement. Socket preservation can be applied at the time of tooth extraction to preserve existing dentoalveolar ridge volumes and contour as well as to promote new bone formation.
Guided Bone Regeneration Graft Options
There are five key bone grafting options for patients who require sinus augmentation, ridge modification, and/or socket preservation. These include: Autogenous bone (bone from the patient), alloplast (synthetic), allograft (cadaver), xenograft (bovine) or tissue engineering through the use of recombinant human bone morphogenic protein-2 (rhBMP-2, a synthetic version of a growth factor signaling molecule/protein which regulates bone healing and growth.) Our doctors will discuss which option is most advantageous for the desired outcomes based on your personalized situation and regional anatomy. A clinical exam and CBCT scan is generally required to customize the right plan for your circumstance and make the best decisions.
†Taba M, Jin Q, Sugai JB, Giannobile W. Current Concepts in Bio Engineering. Orthod Cranio Fac Res 2005; 84(4):292-302.