If teeth have been missing for a long period of time then there are no teeth loading the bone. The bone will shrink and oftentimes you are left with a knife edge ridge which is not wide enough to place implants. When this occurs we need to re-grow the bone width. If the amount of bone loss is very large, or very extensive simple ridge augmentation may not be enough. In this instance your Periodontist may recommend block grafting.A block graft is simply a single large block of bone which is fixated (screwed) to the ridge and allowed to integrate as all bone grafts do. A good analogy is Lego bricks which snap together, only with block grafting we are fixing a block of bone to the ridge. The block needs to heal for 5-8 months prior to implant placement.
Chin BlockWith a chin block the gums are reflected all the way down to expose the chin. A block of bone is removed from the chin and fixated to the ridge where the implants will go. About 30% of the time there is some parasthesia (tingling) of the lower front teeth, and sometimes sensation never returns (this is rare).
Ramus BlockWith a ramus block the gums and cheek are reflected back behind the last tooth on the lower arch. A block of bone is removed and fixated to the ridge where the implants will go. Large blocks of bone can be obtained from the ramus but post-operative pain and swelling can be a problem.
Donor Bank BlocksLarge (and even very large) blocks of bone can be obtained from donor banks. This is also called the Puros block graft. Like all processed bone it is 100% safe and has a well proven record of integration. But the biggest advantage of Puros block graft is that there is no donor site! This saves the patient significant post-operative pain and swelling as well as giving a predictable block of bone every time. The only disadvantage is the additional cost of obtaining the block from the donor banks. Because we prefer this method we only charge the additional material costs without any markup because we want to make this available to patients. Most patients find any additional costs are well worth it in terms of accelerated post-operative healing.
Dr. David has a wonderful chairside manner, just as his father did when I saw him many years ago. He made me feel very comfortable.
I would highly recommend Dr. Engen and his office staff to anyone whose child was apprehensive about having braces. Other than the high level of professionalism, I appreciate the down-play of cutsie-pie gimmicks for kids. He thoroughly explained everything to us right from the start.
Because of the internet information provided about his background and education, I feel I have a top level, up-to-date professional taking care of me.
State of the art care! I like the “get it right” attitude. After eight years I have not had one negative experience.
Lyle B. (Periodontal patient)
Dr. Engen was great! He explained my diagnosis and the procedure required thoroughly. I was even asked if I liked the colors of paint for the office.
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