Glossary

A bone graft is often needed for patients who have suffered bone loss and don’t have enough jaw bone in the area where the implant will be placed. In these cases, bone grafts are typically necessary. This allows a periodontist to place the implant in a way that will be cosmetically pleasing and functional, as well as reduce the risk of implant failure. An alloplastic graft is generally the most frequently used type of bone graft in the implant industry because the material used has excellent hardness and osteoconduction, making it very compatible with the patient’s own bone. The material used for alloplastic grafts is a type of glass made from a naturally occurring mineral in bone called hydroxyapatite. This material is both non-inflammatory and non-carcinogenic, which makes it safe for the patient and particularly effective for bone grafting. Although other types of grafts are available, alloplastic grafts tend to elicit the best results.

Implant hardware surfaces are often treated to help promote osseointegration and the overall success of the implant. Some implants are textured and others have substances applied to the outside of them. Each periodontist has their preference, and some periodontists may choose different types of treated hardware for different patients. One available type of implant is an ion-beam aluminum oxide textured implant. Although in clinical studies the aluminum oxide did not produce a marked difference in how the dental implant performed, it was noted that the implant size helped to increase the chances of implant retention. Ion-beam aluminum oxide is safe and biocompatible, and can help increase BIC, or bone-to-implant contact. Ultimately, it is up to the treating periodontist to discuss goals and options with the patient to determine the best course of treatment and which type of dental implant suits that patient’s particular needs best.

The alveolar ridge is a part of the jaw that holds the teeth and secures their roots. When a tooth is extracted, an empty space or socket is left in the ridge. While this normally fills in with bone and tissue as it heals, this doesn’t always occur successfully. The bone may not grow back properly or there may not have been much bone to begin with. If the patient desires to replace the extracted tooth with an implant, alveolar ridge augmentation may be necessary. This is a surgical procedure that helps to restore the size and shape of the alveolar ridge so that an implant can be placed. A local alveolar ridge augmentation may include only the socket or space where the natural tooth was extracted. In patients who need several implants or have very significant bone loss, bone grafting may be done for the whole ridge.

Alveolar bone is the part of the maxilla or mandible which comprises the tooth-bearing and/or supporting part of the jaw bones. Alveolar bone is frequently the location of dental implants and is one of the three types of tissues that support the teeth. In patients who have lost one or more teeth, the alveolar bone begins to resorb from extended lack of use. When this occurs, the patient must first rebuild the alveolar bone through a bone grafting procedure before dental implants can be placed. Without a bone graft, the insufficient or inadequate alveolar bone can prevent a dental implant from having long-term success. Loss of alveolar bone can also be caused by a facial or dental injury, gum disease, or genetic issues leading to developmental defects. To prevent the loss of alveolar bone due to gum disease, good dental hygiene should be consistently practiced.

The alveolar bone, also called the alveolar process, is the part of the jaw that holds the teeth. The bone here supports the roots of the teeth and keeps them in place. The alveolar bone has two parts — the alveolar bone proper and the supporting alveolar bone. They are generally both the same at a microscopic level, because they both have nerves, blood vessels, cells, and fibers. However, the alveolar bone proper is the area of bone that comes directly into contact with the root of a tooth, or the lining of the socket. The alveolar bone proper is hard, compact bone and not soft, spongy bone. When a dental implant is placed, it comes into direct contact with the alveolar bone proper. Loss of the alveolar bone proper after the extraction of a natural tooth can make dental implants more complex and usually requires the use of a bone graft.

The alveolar crest is the most coronal portion, or the top, of the alveolar process. It is an extension of both the mandible and maxilla and holds the tooth sockets. The alveolar crest is often the first portion of the alveolar process that is damaged by periodontal disease and is therefore the first bone that is lost. The loss of bone at the alveolar crest can prevent a dental implant from achieving long-term success as the bone will not have the density or stability required to support the implant or prosthesis. For patients who have suffered a significant amount of alveolar bone resorption, an alveolar bone graft will be required to build-up the alveolar crest. This type of bone graft will not only provide the tissue required for implant osseointegration but will also add strength and density for the support of implant hardware. To assist in the preservation of the natural alveolar bone, good dental hygiene should be consistently maintained.

Alveolar crestal defects are classified according to ridge height and width:

• Class I – normal apicocoronal ridge height with loss of buccolingual tissue
• Class II – normal buccolingual ridge width with loss of apicocoronal tissue
• Class III – loss of width and height due to a combination of defects

Periodontal disease can cause loss of the alveolar bone, or the bony ridge in the jaw that holds the teeth and supports its roots. The loss of bone typically follow one of four alveolar defect patterns — horizontal defects, angular or vertical defects, dehiscence, and fenestrations. Of the four types of defects, horizontal and vertical defects are the most common. However, general bone loss caused by periodontal disease is most likely to be horizontal bone loss. Generally what occurs with this alveolar defect is that the bone is resorbed by the body and the height of bone decreases uniformly across the affected area. Tooth loss is common with periodontal disease, which creates a two-fold problem. An implant may be a viable solution to replace teeth for functional, health, and aesthetic purposes, yet not enough bone exists to support an implant. In cases of alveolar defect, a bone graft is often necessary.

A common issue of patients needing dental implants is bone loss, or alveolar ridge defects. For a dental implant to be successful, there must be enough bone to support it. Bone grafts are often done, however, new treatment modalities exist, such as alveolar distraction osteogenesis. This procedure involves using a custom made distraction device to augment a deficient alveolar ridge. In studies using this method, the vertical bone gain was significant and did not require a bone transplant. Although some complications were seen as with any alveolar ridge augmentation, the procedure has been identified as a viable one for the augmentation of the alveolar ridge without the need for bone grafting. Bone grafting may have more potential for rejection and complications than alveolar distraction osteogenesis, potentially making this procedure a preferred one by many periodontists. Each patient will need a thorough evaluation to determine if this method is appropriate for their specific needs.

Although dental implants are done for more than aesthetic reasons, including preservation of oral health and function, patients want cosmetically pleasing results. A successful dental implant will be barely, if at all noticeable to the average person and will look and function like a natural tooth. A significant part of the dental implant procedure is to manage soft tissue retraction and exposure of the implant area, since this can have a marked effect on the aesthetic outcome of the procedure. For example, the alveolar mucosa, or the mucosal lining of the dental alveoli, can be affected during an implant procedure when the buccal flap is made. The alveolar mucosa is the soft tissue between the lips and the gums, and it’s important for periodontists to keep this area of the mouth intact during the implant procedure whenever possible. Destruction of the alveolar mucosa during an implant procedure may be considered implant failure, particularly when implants are done in the front of the mouth.