Reasons for Jaw Bone Loss and Deterioration
The following are the most common causes for jaw bone loss and deterioration which may subsequently lead to a bone grafting procedure being required:
When an adult tooth is removed and not replaced, the process of bone deterioration is set in motion. Natural teeth are embedded within the jaw bone and stimulate the maintenance of the jaw bone through activities such as chewing and biting. When teeth are missing, the alveolar bone (the portion of the jaw bone that anchors the teeth within the mouth) no longer receives the necessary stimulation and therefore begins to resorb, or break down. The body receives the message that it no longer “needs” or uses the jaw bone, leading to deterioration.
The rate that the bone deteriorates, as well as the amount of bone loss that occurs, varies greatly among individuals. However, the greatest amount of bone loss takes place within the first eighteen months following a tooth extraction. This process will continue at a more gradual rate throughout one’s life.
Periodontal disease is an ongoing infection of the gums that gradually destroys the support of your natural teeth. Periodontal disease affects the periodontal tissues, which include the cementum (a mineralized tissue layer that covers the root of a tooth sitting inside the gum/bone socket), the gingiva (the gum tissue), the periodontal ligament (connective tissue fibres that attach the root of the tooth to the bony housing within which it sits), and the alveolar bone (the bony housing of the tooth, contained within the jaw bone). While there are many diseases that affect the tooth-supporting structures, plaque-induced inflammatory lesions are responsible for the majority of periodontal issues and are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress to periodontitis, it always precedes periodontitis.
Dental plaque is the primary cause of gingivitis in genetically-susceptible individuals. Plaque is a sticky, colourless film, composed of food particles and various types of bacteria, which adhere to your teeth at and below the gum line. Plaque is continually forming on your teeth, even minutes after cleaning them. Bacteria found in plaque produce toxins that irritate the gums. Gums may become inflamed and swollen (red and puffy) and bleed easily. If this irritation is prolonged, the gums will separate from the teeth causing pockets (spaces) to form. If daily brushing and flossing is neglected, plaque can harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
Gingivitis may progress to periodontitis, when bacteria adhering to the teeth, along with the toxins they create, are also accompanied by an overly aggressive immune response to these bacteria. When gingivitis progresses to periodontitis, both the supporting gum tissue and the bone that holds the teeth in place deteriorate. The progressive loss of this bone, the alveolar bone, can lead to the loosening of and subsequent loss of teeth.
As conventional unanchored dentures rest on top of the gums, they do not provide any direct stimulation to the underlying alveolar bone. Over time, the lack of stimulation causes the bone to resorb and deteriorate. This gradual atrophy of the bone changes the shape of the foundation that conventional dentures sit upon, resulting in loosening of these dentures as well as problems eating and speaking. Bone loss will eventually progress to a state that prevents dentures from staying in place even with repair or relines of the dentures and/or the use of adhesives, such that fabrication of a new set of dentures may be required. Proper denture fit is essential to maintaining oral health.
For dentures supported by anchors (such as teeth and/or implant supported dentures) the presence of the tooth or implant help to adequately stimulate, and therefore preserve bone.
With bridgework, the teeth on either side of the space where the tooth is missing, provide sufficient stimulation to maintain the bone levels of the support teeth. However, the bone below the portion of the bridge spanning the gap where the tooth is missing, receives no direct stimulation. Over time, bone loss will therefore occur in this area.
By performing a bone graft procedure, Dr. Özcan is able to restore a greater volume of bone to the atrophied area, thereby counteracting the bone deterioration that has taken place, yielding an improvement in oral health and dental function.
When one suffers facial trauma involving a tooth being avulsed (knocked out) or broken to the extent that no biting surface remains above the gum line, bone stimulation stops, which results in jaw bone loss. In addition to teeth being avulsed (knocked out) as a result of an injury or accident, other common forms of facial and/or tooth trauma include: suffering an injury or accident which causes a jaw fracture(s), or teeth having a history of traumatic injury that results in the nerve of the tooth eventually dying, or bone loss being experienced years after the initial trauma.
Should bone deterioration result from such circumstances described, a bone grafting procedure would be necessary to reverse the effects of the bone loss, successfully restoring function and promoting new bone growth in the areas subjected to trauma.
Should teeth be misaligned, some teeth may not have an opposing tooth to bite against. An unopposed tooth will therefore over-erupt into the unimpeded space above or below it, which results in the accompanying height of bone around the tooth being lost as it gradually “follows” the over-erupting tooth it is supporting.
Should one experience temporomandibular joint (TMJ) problems and/or grinding/chewing/biting problems, the teeth may be subjected to abnormal physical forces which increase the “wear and tear” on the teeth. These increased physical forces also affect the bone supporting the teeth, which responds by deteriorating.
Osteomyelitis is a form of bacterial infection within the bone and bone marrow of the jaw. This infection leads to inflammation, which can cause a reduction in blood supply to the bone and resulting bone deterioration. Treatment for osteomyelitis generally requires antibiotics and the removal of the affected bone. To address the bone which is ultimately lost due to the disease process itself as well as the treatment required to address it, a bone graft procedure may be indicated to restore bone function.
Benign facial tumors, though generally non-threatening, may be aggressive in nature and grow to be quite large. Removal of benign facial tumors may therefore require the removal of a portion of the jaw. Malignant (cancerous) tumors almost always invade (spread into) the jaw, requiring the removal of the affected portion of the jaw. In both cases, reconstructive bone grafting is usually required to help restore normal function to the jaw. Grafting in patients with malignant tumors may be more challenging as treatment of the cancerous tumor typically requires removal of the surrounding soft tissues as well.
Some conditions or syndromes are characterized by alterations in normal tooth structure, missing teeth, and/or alterations in normal bone structure of the face, jaw and/or skull. In such circumstances, Dr. Özcan may be able to perform a bone graft procedure to restore bone function and growth where it may have been affected/and or be absent.
Some patients have unusually large sinuses in the back of the upper jaw (where the maxillary sinuses are located). These sinuses are “plunging” in nature, extending into the space where the roots of the upper molars are situated. This condition is referred to as “hyperpneumatized sinus”. When such molars need to be removed, sometimes a communication (a hole) may be created between the oral cavity and the sinus. Should a communication occur, closure of this deficiency is required, by performing a soft tissue procedure to re-establish the barrier between the mouth and the sinus.
In the case of placement of implants, at times there is insufficient bone to properly anchor the implant in place.
This condition usually develops over many years and may result in there being insufficient bone for the placement of dental implants. To address this, Dr. Özcan may recommend a “sinus lift” procedure.