The following are the most common causes for jaw bone deterioration and loss that may require a bone grafting procedure:

Tooth Extractions

When an adult tooth is removed and not replaced, jaw bone deterioration will occur. Natural teeth are embedded in the alveolar bone and stimulate it through functioning, such as chewing and biting. When teeth are missing, the alveolar bone no longer receives the necessary stimulation and begins to break down.

The rate that the bone resorbs, as well as the amount of bone loss that occurs, varies greatly among individuals. However, most loss occurs within the first eighteen months following the extraction and will continue gradually throughout a patient’s life.

Periodontal Disease

Periodontal disease is an ongoing infection of the gum tissue that gradually destroys the supporting structures of your natural teeth. Periodontal disease affects the alveolar bone, periodontal ligament, cementum, and/or gingiva. While there are many diseases that affect the tooth-supporting structures, plaque-induced inflammatory lesions make up 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 into periodontitis, it always precedes periodontitis.

Dental plaque is the primary cause of gingivitis in genetically-susceptible individuals. Plaque is a sticky colorless film, composed primarily of food particles and various types of bacteria, that adheres to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produces toxins that irritate the gums. The gums may become inflamed, red, swollen, and bleed easily. If this irritation is prolonged, the gums will separate from the teeth causing pockets to form. If daily brushing and flossing are neglected, plaque can harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.

Periodontitis is affected by the bacteria that adhere to the tooth’s surface, along with an overly aggressive immune response to these bacteria. If gingivitis progresses into periodontitis, the supporting gum tissue and bone that hold the teeth in place deteriorates. The progressive loss of alveolar bone and supporting structures can lead to the loosening and subsequent loss of the dentition.

Dentures/Bridgework

Unanchored dentures are placed on top of the gum line, but they do not provide any direct stimulation to the underlying alveolar bone. Over time the lack of stimulation causes the bone to resorb. Because this type of denture relies on the bone to hold them in place, people often experience loosening of their prosthetics resulting in problems with eating and speaking. Eventually, bone loss may become so severe that dentures cannot be held in place with strong adhesives, and a new set of dentures may be required. Proper denture care, repair, and refitting are essential to maintaining oral health.

With bridgework, the teeth on either side of the appliance provide sufficient stimulation to the bone, but the portion of the bridge that spans the gap where the teeth are missing receives no direct stimulation resulting in bone loss in this area.

Facial Trauma

When a tooth is dislodged or broken, or when the supporting bone is fractured resulting in the loss of the dentition, the remaining bone will continue to deteriorate. Some common forms of tooth and jaw trauma include: teeth dislodged from injury or accident, jaw fractures, or teeth with a history of trauma that may become non-vital thus leading to bone loss years after the initial trauma had occurred.

Misalignment

Misalignment can occur when teeth no longer oppose each other. The unopposed dentition can over-erupt, causing loss of the underlying bone. Misalignment can also cause TMJ problems or abnormal wearing of the remaining dentition (attrition), which can create adverse physical forces that interfere with normal function, thus allowing the bone to deteriorate.

Osteomyelitis

Osteomyelitis is a bacterial infection of the bone. This infection leads to inflammation, which can cause a reduction in blood supply to the bone itself. Treatment for osteomyelitis generally requires IV antibiotics and the removal of the affected bone. Sometimes resection of these areas can become quite large requiring the need for both particulate and block bone grafts. Reconstruction is performed in a hospital setting under general anesthesia.

Tumors

Benign facial tumors, though generally non-threatening, may grow large and require the removal of a portion of the jaw. Malignant head and neck tumors may spread into the jaw, requiring the removal of both the affected bone as well as the adjacent soft tissue. In both cases, reconstruction with various bone and soft tissue grafts is required to restore normal form and function. These procedures are performed in a hospital setting under general anesthesia.

Developmental Deformities

Some conditions or syndromes are characterized by missing portions of the teeth, facial or cranial bones.

Sinus Deficiencies

When molars are removed from the posterior upper jaw, air pressure from the maxillary sinus causes resorption of the alveolar bone. As a result, the sinuses become enlarged, a condition called pneumatization. This condition usually develops over several years and may result in insufficient bone for the placement of dental implants. Dr. Pierse can perform a sinus lift which may provide a treatment alternative that allows for implant placement.

Contact Precision Oral and Maxillofacial Surgery online or by phone at (623) 518-2325.