Yes, several alternatives are available to avoid bone grafting in some situations. Ridge expansion is one technique that can be used to avoid bone grafting in the upper jaw. The upper jaw bone has a higher modulus of elasticity than the lower jaw bone, meaning it is softer. Because of this softness or plasticity we can expand the bone instead of drilling it. By mechanically expanding the bone we do not waste or discard the bone.
To better understand this concept think of a carpenter. When wood is cut or drilled the process produces sawdust. Sawdust is the by-product of cutting or drilling into the lumber. What happens to the wood and the sawdust? The wood is forever changed and the sawdust blows away, gets swept up or remains on the floor as garbage. The same is true of “bone dust”. As we drill into the bone with our implant drills the discarded bone or “bone dust” is removed by the dental assistant with the suction. Much like the carpenter’s sawdust, once it’s gone, it’s gone!
Ridge expansion utilizes hand instruments to “expand” the bone instead of drilling it. Osteotomes are the name of the instruments that expand bone. They are purchased in sets of progressively larger diameters. This can take from 10-30 minutes depending on the bone density. First, a small pilot hole is drilled. Second, an osteotome slightly larger than the hole is placed in the opening of the hole. The first osteotome may be 0.5 mm larger than the pilot hole. Third, each progressively larger osteotome is used to dilate the site to the desired diameter. With time, energy and patience the dentist can dilate a 5 mm ridge up to 9 mm without removing any bone, thereby avoiding the bone graft.
In the lower jaw bone ridge expansion is not possible because the bone is so dense and hard. As an alternative to bone grafting, shorter implants can be used. There is often more bone in the lower jaw than is expected. Because the bone deteriorates in a different pattern for the lower jaw there appears to be less bone than most dentists realize. A procedure called “alveoplasty” can be utilized. The word “alveo” means bone and “plasty” means reshaping. By performing this procedure before implants are placed a careful and patient dentist can locate the widest part of the lower jaw bone and still place implants without a bone graft.
Both ridge expansion and alveoplasty are under-utilized in implant dentistry. The main reason for this is that both procedures take patience, time and skill. Very few dentists use this for patients who could greatly benefit from them.