Osteoplasty

Osteoplasty is a set of measures aimed at increasing (augmentation) bone volume.

Bone augmentation can be: vertical – aimed at increasing bone tissue height; horizontal – aimed at increasing bone tissue width.

Osteoplasty (bone grafting) has quite a wide application in various fields of medicine:

• dentistry;
• traumatology;
• orthopedics;
• surgery.

• critically low bone volume during implantation;
• critically low bone volume during prosthesis placement;
• congenital and acquired bone shape anomalies;
• bone structure damage after neoplasm removal;
• bone structure damage due to injuries;
• bone tissue atrophy.

In cases where periodontitis (inflammation of the periodontium) has led to the destruction of bone tissue around the tooth, doctors may recommend osteoplasty. Osteoplasty for periodontitis is necessary for bone tissue regeneration and defect correction.

Despite the wide range of applications for osteoplasty in dentistry, in most clinics bone augmentation is performed for the purpose of further prosthetics on implants. At “Dr. Osadchiy’s Dental Clinic” we do not recommend osteoplasty to patients who do not have absolute indications for such surgery. When implantation is necessary in conditions of low bone volume, we use short “plateau” system implants and avoid bone grafting procedures.

Osteoplasty involves a surgical procedure that can only be performed by a dental surgeon or maxillofacial surgeon. Depending on the clinical picture, the surgical scenarios may vary, but in general, a bone grafting procedure consists of the following stages:

1. Diagnostics (examination, radiography and/or computed tomography (CT) to obtain detailed information about bone structure).
2. Patient preparation (the surgery can be performed under general or local anesthesia, depending on the degree of complexity).
3. Obtaining transplant material (osteoplasty involves transplantation of bone material, its varieties are described further).
4. Zone preparation (surgical access to the transplantation zone is created).
5. Restoration or augmentation of bone tissue volume.
6. Fixation and closure (after material implantation, special screws may be used for stabilization).
7. Recovery and rehabilitation (the average rehabilitation period is 8–12 weeks).

Depending on the material used for bone augmentation, the following types of osteoplasty in dentistry can be distinguished.

It should be noted that autogenous osteoplasty involves harvesting the patient’s own material, most often from nearby areas – the chin. The bone area in the chin regenerates over time. Autogenous osteoplasty using material from distant areas (little toe, hip, parietal bone, etc.) is also possible.

There is an opinion that the transplanted material takes root in the transplantation zone and forms bone. However, in practice, the situation is as follows: the transplanted material is “consumed” by macrophages (protective blood elements). Then osteoblasts form elements of bone tissue. However, no tissue obtained through osteoplasty will have the same differentiation (quality) as the patient’s original bone tissue.

Bone grafting procedures of the upper and lower jaws are similar in many ways, but there are also a number of differences:

• by access.

Upper jaw osteoplasty is complicated by the fact that it is more difficult for the surgeon to gain access due to the sinuses, nasal cavity, and other structures;

• by type of procedures.

The upper and lower jaws may require different types of osteoplastic procedures depending on the nature (atrophy) of bone tissue loss. For the upper jaw, sinus lifting (a procedure to increase bone tissue volume in the posterior part of the upper jaw) is quite often required;

• by risk of material loss.

Lower jaw osteoplasty generally proceeds more effectively, and recovery is faster. However, the anatomical features of the upper jaw result in an increased risk of material loss;

• by rehabilitation period.

After osteoplasty in the upper jaw, more careful monitoring and a longer rehabilitation period may be required due to the healing characteristics in this area.

Osteoplasty, like any surgical procedure, may be accompanied by various complications:

• site infection;
• improper healing with epithelial tissue or scar formation;
• graft rejection;
• mucosal inflammation;
• lack of osseointegration (unable to place an implant);
• uneven bone tissue growth.

Bone grafting procedures have a number of contraindications:

• systemic bone diseases (osteoporosis, oncological diseases);
• chronic diseases (diabetes mellitus, heart failure);
• presence of infection in the area of the intended transplantation;
• immune system disorders;
• blood clotting disorders;
• mental disorders;
• pregnancy.

The price of osteoplasty in Kyiv starts from 12 thousand hryvnias, but the full cost of all procedures will be much higher. A significant factor affecting the price of osteoplasty is the type of transplantation material. If the patient’s own tissues are used, the price will be higher due to additional material harvesting procedures. If foreign material is used, the final cost will include the price of the transplant.

Osteoplasty is associated with risks of graft non-survival and requires direct medical indications. Our practice shows that in most cases during implantation, bone grafting procedures can be avoided and short “plateau” system implants can be placed in conditions of bone volume deficiency.

At “Dr. Osadchiy’s Dental Clinic” we perform augmentation for aesthetic indications (for example, when there is insufficient bone volume in the visible smile zone). The advantage of such procedures is that we do not place an implant in the augmented area – we do not add additional load. Therefore, when bone remodeling occurs in the operated zone (not fully bone tissue), this will be sufficient for aesthetic improvement.